Progressive Ear Therapy (PET)

Reading messages on the Hyperacusis Network forum, I came across the case of Rob, who, lacking disability benefits in his country (USA) and needing to keep paying bills, was forced to cope with very severe hyperacusis, having to expose himself to numerous sounds that caused him pain and setbacks.

Determined to find a way to recover from his extreme decrease in sound tolerance despite the enormous obstacles he faced, he studied hyperacusis, read as much as he could on the topic, contacted the world’s leading hyperacusis specialists, tried different options, and ultimately developed a protocol to treat his hyperacusis, based primarily on TRT (Tinnitus Retraining Therapy), a therapy initially developed to treat tinnitus but later found by its creators to also be applicable for hyperacusis. He published this protocol on the Hyperacusis Network forum, where he has become one of the most important mentors.

Using his protocol, he managed to go from UCLs (Uncomfortable Loudness Levels) of 30–40 dB to UCLs of 90–100 dB. I consider his method extremely interesting because, although it essentially consists of listening to pink noise and gradually increasing the volume, the approach is considerably different from the method I have used, mainly because he refused to use hearing protection. With his permission, I have translated it, and it is what we are going to examine next.

Before starting, it should be clarified that Rob wrote this message many years ago and had not yet completed the therapy, so he likely refined the method and corrected some aspects, but I have not found a more updated version. Even so, I considered the text sufficiently interesting to “post” it here. At the end of the message, I will make some comments on certain aspects that deserve special attention.

You can view the original post here: http://www.chat-hyperacusis.net/post/a-protocol-for-progressive-ear-therapy-pet-954319 ... pet-954319

I’m going to highlight some points about Rob’s text that I think are worth emphasizing and exploring further.

Rob discusses two ways of setting the volume for sound therapy: one advocated by Dr. Jack Vernon (which is the method I have used) and the other by Dr. Jastreboff, which involves using very low volumes. Both approaches have advantages and disadvantages.

Using the highest comfortable volume and increasing it every three days or a week can, if done carefully, allow recovery from hyperacusis much faster than using very low volumes and increasing them monthly. I want to note that once I realized that during relapses I should continue listening to what I had already tolerated—ignoring the discomfort—and not start over, I went from being unable to watch TV even at the lowest volume to walking down a busy street in about three months. In contrast, Rob did not see any improvement in the first six months of therapy. However, it is essential to clarify that my rapid improvement would not have been possible without being able to stay isolated at home and maintain strict control over the sounds I exposed myself to.

That said, I also think that Vernon’s method of adjusting volume may be unfeasible in some cases, because the volume of the pink noise is near the tolerance threshold, which can cause serious difficulties if the ears have already been overexposed. Without proper precautions, this can worsen pain and sound tolerance symptoms. Using very low volumes, by contrast, allows almost any ear situation to be handled, making it a safer approach.

There is something extremely interesting about Rob’s method. Despite what he wrote in his protocol description, which sounds contradictory, he managed to improve with an extremely low tolerance threshold without protecting himself from everyday sounds that caused pain and relapses. I asked Rob directly about this, and he confirmed it. He only used hearing protection in very exceptional cases and continued to go outside, have conversations, hear barking dogs, children screaming, and printer beeps—all without earplugs. This caused significant pain and relapses, but over time, fewer sounds caused discomfort. Rob considers this approach essential to restoring normal sound tolerance, hence his insistence on using open headphones to continue receiving ambient sound. He even describes listening to pink noise in a silent room as useless (although I believe he is mistaken here, as I recovered in a silent room).

The key takeaway is extremely important. Contrary to what I strongly believed from my own experience, Rob’s case and those of others show that it is possible to recover from hyperacusis even while being exposed to sounds above the tolerance threshold continuously. This offers great hope to people in similar situations who might believe they can never recover unless they protect themselves from all discomfort-causing sounds.

Another point worth mentioning is the maximum volume used with pink noise. According to Dr. Jastreboff, one should not use a volume (with open headphones or sound generators) that makes conversation difficult. Practically, this means pink noise should never exceed 60 dB. It may be surprising that setting the maximum pink noise volume at 60 dB can still restore sound tolerance to UCLs of 100 dB. In my opinion, reaching a UCL of 100 dB at some point requires exposing the ears to that intensity, even for very short periods. With Rob’s method, this is achieved through everyday sounds while minimizing the use of hearing protection. This approach is, for him, essential to restoring normal sound tolerance.

Another aspect of Rob’s protocol is the pink noise bandwidth. Both the Hyperacusis Network CD and the pink noise I provide cover 1–22,050 Hz, stimulating the entire audible spectrum. However, Rob initially could not tolerate this full range and had to reduce the upper frequency limit to 3,000 Hz, meaning he could only tolerate a very narrow bandwidth at first. While not common, it’s useful to be aware of this possibility and how to address it.

In my view, Rob’s therapy is most suitable for cases where individuals with hyperacusis are exposed to constant noise above their tolerance and cannot use hearing protection or avoid exposure. It’s encouraging to know that even in these cases, recovery is possible. However, enduring the pain from intolerable sounds is not easy. I believe that the approach of ignoring everyday sounds entirely is neither the most effective nor efficient. The key is controlled exposure to everyday sounds, managing the duration with hearing protection or by avoiding excessively noisy environments (without overprotecting), and gradually relaxing this control as tolerance improves. From my experience, this allows a faster and far less painful recovery.