Hearing Protection

To protect ourselves from loud sounds or sounds above our tolerance level, we can use earplugs or earmuffs. In the case of earplugs, there are several types: foam, silicone, moldable silicone, custom molds, filtered plugs, musicians’ plugs… Each type offers different levels of protection (from 9 dB up to 33 dB or more), with foam and moldable silicone plugs providing the highest protection.

Some are more comfortable to wear than others and not all of them work for everyone. The plugs you should use depend on the severity of the hyperacusis, the intensity of the noise you want to protect yourself from, how long you will be wearing them, and whether you can insert them correctly, etc. Since most of them are quite affordable, it is best to try different models and stick with the ones that best suit your needs. Most plugs can be found in pharmacies. For custom molds, you need to visit an audiologist.

Foam earplugs

In general, custom-made musicians’ plugs are recommended. The reasons are that they attenuate the entire frequency spectrum more or less evenly between 125 Hz and 8000 Hz, which allows for a listening experience closer to what you would hear without plugs, just at a lower volume. In addition, because they are custom made, they can be worn for long periods with complete comfort. Finally, they do not block air from passing into the ear canal. The downside is the price (around €180), and the fact that the maximum protection they offer, while sufficient for most people, may be insufficient in some cases.

As far as earmuffs are concerned, they offer protection similar to earplugs. If someone finds it unbearable to wear something inside the ear canal, earmuffs can be an alternative, although they are uncomfortable over long periods because they press on the ears and eventually cause pain. Obviously, earplugs are far more discreet than earmuffs. It’s one thing to wear earmuffs while mowing the lawn and quite another to wear them in a shopping centre. Another advantage of earmuffs is that you can put them on and take them off quickly, which can be useful in some situations.

Hearing protection earmuffs

Contrary to what one might think, wearing earplugs and earmuffs at the same time does not provide the same protection as the sum of the attenuation offered by each separately. There is a maximum attenuation value that cannot be exceeded — we must not forget that we also hear sound via bone conduction. However, wearing plugs and earmuffs together does provide more protection than using them separately, which can be very helpful depending on the sound you are exposed to.

Another form of hearing protection is the use of active noise-cancelling headphones. These headphones are designed to reduce outside noise and improve listening by playing back the external noise with inverted phase (a sound wave added to an identical wave in inverted phase causes cancellation). I’ve read positive feedback from people with hyperacusis who use this type of headphones, but you need to keep in mind that they only cancel constant sounds well, such as engine noise, and not sounds with a lot of variation or impact sounds. You will still be able to hold a conversation with them on. Their protection with the noise-cancelling function disabled is very low, and cannot be compared with that of proper hearing protection earmuffs. In my opinion, they can be useful in mild/moderate cases and in certain situations, but they should not be considered a substitute for conventional hearing protection.

As mentioned in the article Hyperacusis Treatment, hearing protection is a double-edged sword. The help it provides in avoiding relapses and recovering some of the quality of life we had before hyperacusis makes it practically indispensable. However, indiscriminate use can worsen our sound tolerance.

The real problem begins when, through the use of hearing protection (or even without it, by avoiding all noisy environments), we stop hearing a certain intensity of sound repeatedly. If maintained over time, this leads the brain to “forget” what it is like to hear that intensity, causing the sound-tolerance threshold to decrease. If brain plasticity allows us to retrain the brain to tolerate loud sounds again, that same plasticity can also cause tolerance to drop.

Custom-made earplugs

The correct way to use hearing protection is to use it only to protect yourself from sounds that could make you relapse or cause hearing damage, while at the same time not completely avoiding the everyday sounds that bother you — even if only for brief moments.

Let’s consider an example. Suppose your tolerance level is such that, after a few minutes on a bus, you notice that your ears can’t stand it anymore, and you realise at the end of the journey that your ears are more sensitive and sore. The logical decision would be to use hearing protection every time you take the bus, so that you can complete the journey without problems and without worrying about the noise. And since this works, you end up applying the same strategy to every other potentially risky situation in daily life. However, this is a mistake. In this way, you set in the brain the highest volume threshold you can tolerate from the loudest sounds you still hear with no plugs — in other words, you are worsening your hyperacusis. Therefore, going back to the bus example, the correct thing to do is to expose yourself to the bus noise without protection and stay in it as long as you can, until you start to feel that continued exposure could reduce your tolerance or cause pain. At that point, you should indeed use protection to avoid overexposure. Avoiding overprotection is one of the keys to preventing hyperacusis from getting worse.

This approach, however, may introduce another problem: being constantly alert to surrounding sounds and repeatedly putting in and taking out earplugs can become stressful and exhausting. You should try not to reach this point and avoid becoming obsessed with controlling every situation in which your ears might receive excessive exposure, as this hypervigilance can contribute to the development of phonophobia. If you have to choose between exposure or protecting yourself for a few hours to avoid that stress, it’s always better to protect yourself and stay calm — because later in the day you can compensate for the time spent with protection by exposing yourself to other sounds in a controlled way, whereas overexposure might trigger a relapse from which it may take a long time to recover.