To this day, sound therapy as a treatment for hyperacusis remains a controversial topic. On the one hand there are patients who have improved, but there are also others who have worsened. On the other hand, we have professionals who are for it, but also professionals who are totally against it. The little scientific evidence on the subject makes it a highly controversial topic today.
For this reason, sound therapy should be viewed as one of many tools that can be used as part of an overall recovery strategy. It is not the panacea. It’s slow, it doesn’t work for all patients, and it doesn’t necessarily lead to a full recovery. Also, those who have recovered are at risk of relapse after being exposed to loud sounds.
It must be said that the failure of many of these sound therapies may be due to a bad strategy, in many cases generic sound therapies are used, without personalizing determining factors such as exposure time, intensity and color of the sound. depending on the causes and degree of hyperacusis of the patient. In this article we will talk about factors to take into account to minimize this type of frequent errors that cause many therapies to fail.
Factors to take into account to do an adequate sound therapy in hyperacusis
As we have seen, a bad strategy when doing sound therapy can make the patient with hyperacusis worse, something that we must avoid at all costs, because any relapse will mean that the recovery time is lengthened. Next we will talk about the main factors to take into account to, later, propose a methodology for sound therapy in Hyperacusis.
Sound Color Choice in Hyperacusis – Pink Noise, Brown Noise or White Noise?
The most recommended sound for sound therapy is pink noise, a broadband noise similar to that produced by analog television when no channel was tuned. What makes this sound ideal for sound therapy in hyperacusis is that, in addition to being a broadband noise (which covers the frequency spectrum of the human ear), the sound intensity decreases as it approaches higher pitched sounds (which are the ones that bother patients with hyperacusis the most). Amplifying bass sounds more than treble sounds.
For Severe Hyperacusis, brown noise may be more suitable than pink, since it amplifies the high frequencies even less than pink noise.
If you want more information on Pink and Brown Noise for Sound Therapies in Hyperacusis, see the following article:
Choosing the Intensity of Sound Therapy in Hyperacusis
The sound intensity is going to be fundamental when doing the therapy, the main thing is not to exceed the patient’s threshold of discomfort. Later we will see that we can play with the intensity depending on the exposure time, getting closer or further away from the patient’s sound tolerance limit depending on the exposure time.
Most patients with hyperacusis explain that it is as if they have a daily “limited sound quota” that, when exceeded (either by minimally intense but impactful sounds or by low intensity sounds but with a high exposure time), their UCL pain threshold is shortened, thus shortening the dynamic range with which they can listen with some comfort, and making almost any noise unbearable. Therefore, it should always be done below the patient’s hearing tolerance limit.
Choice of Exposure Time for Sound Therapy in Hyperacusis
Sound exposure time is the amount of time a patient remains exposed to a type of sound, whether more or less intense. Correctly adjusting this exposure time to the degree of hyperacusis of the patient will be essential to avoid failure and relapse of the patient with sound therapy.
As we have mentioned, most patients have a “limited sound quota” and, although the intensity of the sound is negligible, if we subject it to very long exposure times, we can exhaust this quota. For this reason, it is important to start very little by little and progressively increase the exposure time.
The success or failure of sound therapy in Hyperacusis will be given by an adequate adjustment in sound intensity and exposure time. Accompanied by a good choice of sound color according to the patient’s degree of hyperacusis.
The sound source for therapy should be Hi-Fi speakers or headphones
High fidelity (often abbreviated Hi-Fi) is a quality standard that means that sound reproduction is very faithful to the original. High fidelity aims to keep noise and distortion to a minimum. It is necessary to use this type of sound sources so that the entire frequency spectrum is reproduced well.
In the case of the speakers, it is advisable to place ourselves between the two speakers as if they were headphones, at a distance of 1.5 meters from the ears.
In the case of headphones, the recommendation is that they be open supraaural so that, in addition to the sound emitted by the headphones, they allow the ambient sound to be heard as well. It is also necessary that they have a frequency response as flat as possible, this means that they do not have excessively accentuated bass or treble.
There is diversity of opinion regarding the choice of sound source: Headphones or Speakers?
Some people think that headphones are more effective than speakers and vice versa. Headphones seem to stimulate the auditory system better, but should be used with caution if exposure is prolonged. It should also be borne in mind that the difference in volume between one point and another is much more noticeable with headphones than with speakers. A disadvantage of loudspeakers is that they reduce mobility and force us to remain in one place during the period of time of the therapy.
In either case, the maximum volume should never exceed 85dB!
SOUND THERAPY PROTOCOLS IN HYPERACUSIA
In the first place, it must be said that the optimal thing would be to do the therapy with a specific and personalized protocol for each patient, avoiding generic sound therapies for everyone. For this reason, the protocols that will be described below can serve as a basis, but the therapy must be modified and personalized for each patient.
We can classify the strategies to follow according to the time of exposure to sound and its proximity or distance from the patient’s sound intolerance threshold.
DISCLAIMER: These therapies SHOULD NOT CAUSE PAIN or CAUSE EARS TO BECOME MORE SENSITIVE TO SOUND! If so, ABORT MISSION!
Short-Term Therapy with Sound Intensity Close to the Intolerance Level
Short Term Therapy consists of a daily session of 10 minutes of pink noise. In it, the patient will be exposed to a volume a little below the limit of her tolerance. This short therapy is especially useful in severe hyperacusis, since being so short it is easier to tolerate and allows a higher volume to be used than other longer lasting therapies.
Because the patient will be exposed to a sound close to their intolerance threshold, it should always be done when the ears are rested. If they are not, its duration should be shortened when necessary, or even suspended.
Once we have found the appropriate volume level, it will continue with that intensity for 3 more days, and on the fourth day it will go up one more point.
If during the session the patient feels that the volume is too high and the desire arises to finish as soon as possible, it is best to abort the session, otherwise it could leave his ears very sensitive and cause a relapse.
During the practice of these therapies, it will be an essential condition that THE 85dB LIMIT IS NOT EXCEEDED. Once you have reached that point, the next step will only be to work with the exposure time.
Long-term therapy with sound intensity far from the level of intolerance
If the goal of short-term therapy is to train the brain to withstand louder sounds, long-term therapy is to train the brain to withstand longer exposure times.
Unlike the volume in short-term therapy, in this strategy the volume should not be close to the tolerance limit. The volume should be as high as the patient can tolerate during that time without pain or discomfort. If during the session the patient notices the slightest discomfort, the mission should be aborted.
You can start with 30 minutes and gradually increase the exposure time until you reach 2 hours in a row. The time can be increased in steps of 5 or 10 minutes. Once you reach 2 hours in a row, you should turn up the volume one notch and start with 30 minutes of exposure time.
The next step will be to progressively go from 2 hours to at least 8 hours a day, preferably in a row. Obviously, this step will only be possible to do with headphones, due to the mobility restrictions involved in doing the therapy for 8 hours with speakers. The maximum volume to which it is adjusted must be that in which the patient is allowed to have a conversation without problems, which in practice does not exceed 60dB.
!DISCLAIMER!: Antes de escuchar estos audios asegúrate de que el volumen no sea alto y el dispositivo desde el que los reproduces sea de Alta Fidelidad (Hi-Fi).
Listen Pink Noise Online – Hyperacusis and Tinnitus
Listen to Brown Noise Online – Hyperacusis and Tinnitus
Listen to White Noise Online – Tinnitus
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