Please help me regarding Tinnitus
Apr 30, 2008 at 2:33 AM Post #31 of 48
Manaox2, I don't think we talked about Meniere's disease, which is genetic with tinnitus and hearing loss. The Meniere's Page

Ménière's disease is usually characterized 4 symptoms.
1) Periodic episodes of rotatory vertigo or dizziness.
2) Fluctuating, progressive, low-frequency hearing loss
3) Tinnitus
4) A sensation of "fullness" or pressure in the ear.

PS: I am the Pediatrician of the bunch, not the ENT...
 
Apr 30, 2008 at 2:37 AM Post #32 of 48
Not all tinnitus is chronic. Sadly I have the chronic variety (confirmed by an audiologist), as well as some high-frequency loss, in my left ear due to insufficient hearing protection when operating a firearm.

Really, it would have been temporary save for the trees and rocks to my left were causing the sound to bounce around crazily and slam into my ear. It's a queer experience to have your right ear perfectly fine after the ringing stops, but your left ear feel like it has cotton gauze stuffed up inside it. Oh, and there was the blood, also.
 
Apr 30, 2008 at 3:00 AM Post #33 of 48
i used to have tinnitus when i was a kid ~5 years old. i distinctly remember being home by myself and hearing a constant ringing all around me. it decided to go away after i started school... until i got a mid ear infection in fourth grade (which also took away hearing in ultra-high frequencies). that plus some loud listening in high school. now i hear the ringing when i just get home from work, pretty loud too. but strangely it goes away after dinner. i don't even hear it at night.
 
Apr 30, 2008 at 3:36 AM Post #34 of 48
On occasion I suddenly lose hearing in one of my ears, and then it gradually returns (picture a plot of the intensity of loss versus time as I*exp(-10t) vs. t). What would cause this (it's not wax)?
 
Apr 30, 2008 at 12:44 PM Post #35 of 48
Quote:

Originally Posted by HeadphoneAddict /img/forum/go_quote.gif
Do you think a 2 week course of Vancomycin for MRSA in 2001 could cause my Rt ear tinnitus, even though I know they monitored blood levels of the drug?


I know you were asking the ENT, but after I got tinnitus following a prescription drug I bought a book called "Ototoxic Drugs Exposed" by Neil Bauman. To summarise what the books says about Vancomycin, it says it can cause significant hearing loss which is frequently permanent. Sometimes the hearing loss is preceded by tinnitus. The hearing loss may be progressive and may continue to get worse after one has stopped taking the drug.

You can take the above or leave it
wink.gif
It's just another book afterall, but after I found the drugs I had been given listed in it, I will always avoid anything listed in that book in the future unles there is a very compelling and irrefutable and near-life threatening reason to take it.

Getting tinnitus after taking a drug prescribed by your Doctor for a condition that in hindsight did not even need the drug...well I can't even begin to tell you how that episode has changed my life.
 
Apr 30, 2008 at 1:19 PM Post #36 of 48
Quote:

Originally Posted by HeadphoneAddict /img/forum/go_quote.gif
Do you think a 2 week course of Vancomycin for MRSA in 2001 could cause my Rt ear tinnitus, even though I know they monitored blood levels of the drug? When I stop talking my Sulfasalazine, the tinnitus doesn't go away, but my ability to walk does...

Oh wait, this isn't a "free advice from the doctor forum" yet, bummer
tongue.gif



Unfortunately yes, but it's infrequent that a drug induced tinnitus affects just one ear and and is not associated to some hearing loss. Your tinnitus might be for another cause.

Some drugs are considered ototoxic because at therapeutic levels they can damage without recovery the hairy cells of our cochleas. It depends on individual sensivity, but also is dose dependant. If you get a high dose then the damage is sure, but at controlled low levels, it depends on your own sensivity that you get hearing loss and tinnitus or not.

Sulfasalazine is of the same family as ASA and can induce temporary hearing loss, dizziness and tinnitus if used at high doses, but it's not common at therapeutic usual levels. This should be reversible once the treatment is stopped. I'm sorry to know you need to be treated with Sulfasalazine
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Take care.

Rgrds
 
Apr 30, 2008 at 8:20 PM Post #37 of 48
Quote:

Originally Posted by ADD /img/forum/go_quote.gif
I know you were asking the ENT, but after I got tinnitus following a prescription drug I bought a book called "Ototoxic Drugs Exposed" by Neil Bauman. To summarise what the books says about Vancomycin, it says it can cause significant hearing loss which is frequently permanent. Sometimes the hearing loss is preceded by tinnitus. The hearing loss may be progressive and may continue to get worse after one has stopped taking the drug.

You can take the above or leave it
wink.gif
It's just another book afterall, but after I found the drugs I had been given listed in it, I will always avoid anything listed in that book in the future unles there is a very compelling and irrefutable and near-life threatening reason to take it.

Getting tinnitus after taking a drug prescribed by your Doctor for a condition that in hindsight did not even need the drug...well I can't even begin to tell you how that episode has changed my life.



My condition was life threatening, as a methicillin resistant staph areus infection that resulted in me coughing up half my blood and also needing a blood transfusion. Didn't have many other options for staying alive but to get intravenous vancomycin through a central line...
 
May 1, 2008 at 1:17 AM Post #38 of 48
Quote:

Originally Posted by HeadphoneAddict /img/forum/go_quote.gif
My condition was life threatening, as a methicillin resistant staph areus infection that resulted in me coughing up half my blood and also needing a blood transfusion. Didn't have many other options for staying alive but to get intravenous vancomycin through a central line...


I'm sorry to hear that. I never meant to insinuate that the medication you were given was not essential or prudent under the circumstances. But by the same token (and again, I am not talking about your case specifically) it is also important for people to realise that often another, non-ototoxic drug can achieve the same outcome as an ototoxic one. In my case, for example, Augmenten Forte did precisely the same thing the Ciproxen did, but it had absolutely no side effects to my hearing whatsoever. But I was suffering debilitating tinnitus for the first time in my life 6 hours after taking Ciproxen.

I just hope that one day they will invent a pill that relieves the symptoms of tinnitus or even better cures it
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This will all probably become a reality the day after I die
tongue.gif
I know there are currently more pill and herbal treatments for tinnitus than you can poke a stick at. But they don't work - it's just the placebo effect that makes it seem like they work.

Just on the subject again on headphones and tinnitus, I feel there is possibly some relationship between somatic tinnitus and the wearing of full size headphones, rather than the seemingly more obvious one of listening too loudly for too long. I know in my case there is certainly a major somatic component to my tinnitus. This is something I have mentioned to my GP and I am hoping there might be a specialist I can be referred to who is an expert in the neck and jaw and their effects upon tinnitus.

I have had chronic pain since I was assaulted by a gang of 5 people back in 1997 (my reward for doing nothing more than walking home alone from the railway station on a Sunday afternoon). I had to retire from work several years ago because I could no longer cope with the pain.

But the effect on my neck was profound. I can triple the volume of my tinnitus my moving my head from side to side or tensing the muscles than are between my neck and chin (whatever they are called lol). And just a few days ago, I got a severe attack of tinnitus in my left ear (of exactly the same sound quality as normal, but unbelievably loud) when a warm puff of air from an airconditioner hit me on the left side of my neck when I was walking past it (1 second puff of air equalled 60 seconds of deafening left ear tinnitus!).

Anyway, this has me thinking that for people who may have tendencies toward somatic tinnitus, their conditions might possibly be aggravated when wearing full sized phones. Why? Because for one, when listening with full sized headphones, there is all that extra weight on the head which might cause additional tension in the neck and jaw muscles. And for two, we tend to not move our heads around much when listening on headphones. Again, that is sometimes not good news for people with a tendancy towards neck tension. You only have to think how much we sometimes hurt in the upper back and neck after sitting in front of a computer and not moving around much - with music listening it is often the same posture with even less movement.
 
May 1, 2008 at 2:02 AM Post #39 of 48
Quote:

Originally Posted by HeadphoneAddict /img/forum/go_quote.gif
Manaox2, I don't think we talked about Meniere's disease, which is genetic with tinnitus and hearing loss. The Meniere's Page

Ménière's disease is usually characterized 4 symptoms.
1) Periodic episodes of rotatory vertigo or dizziness.
2) Fluctuating, progressive, low-frequency hearing loss
3) Tinnitus
4) A sensation of "fullness" or pressure in the ear.

PS: I am the Pediatrician of the bunch, not the ENT...



Yeah, I think this is something I might want to worry about. Thanks.
 
May 1, 2008 at 7:35 AM Post #40 of 48
Quote:

Originally Posted by ADD /img/forum/go_quote.gif
...
But the effect on my neck was profound. I can triple the volume of my tinnitus my moving my head from side to side or tensing the muscles than are between my neck and chin (whatever they are called lol). And just a few days ago, I got a severe attack of tinnitus in my left ear (of exactly the same sound quality as normal, but unbelievably loud) when a warm puff of air from an airconditioner hit me on the left side of my neck when I was walking past it (1 second puff of air equalled 60 seconds of deafening left ear tinnitus!).

Anyway, this has me thinking that for people who may have tendencies toward somatic tinnitus, their conditions might possibly be aggravated when wearing full sized phones. Why? Because for one, when listening with full sized headphones, there is all that extra weight on the head which might cause additional tension in the neck and jaw muscles. And for two, we tend to not move our heads around much when listening on headphones. Again, that is sometimes not good news for people with a tendancy towards neck tension. You only have to think how much we sometimes hurt in the upper back and neck after sitting in front of a computer and not moving around much - with music listening it is often the same posture with even less movement.



I can also increase the volume of my tinnitus threefold, in much the same way you can, except for the puff of air thing. Wierd. I have tons of musculoskeletal issues, and am on tons of meds that I just couldn't get into right now. I'm 46 and feel like I'm 80 sometimes.
 
May 1, 2008 at 10:54 AM Post #41 of 48
Quote:

Originally Posted by HeadphoneAddict /img/forum/go_quote.gif
Oh wait, this isn't a "free advice from the doctor forum" yet, bummer
tongue.gif



OK, my turn
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How does one go about determining maximum safe listening levels for classical music? It's easy for the people who listen to all that compressed modern, electronic pop stuff, since if they listen at 80 dBA, then...that is 80 dBA give or take a couple of decibels. So it is relatively easy to go by those guidelines that we see published.

But for my classical music, if I were to set the volume so the peaks were at, say 85 dBA, then the listening experience would be in the main very quiet and nothing even remotely like a live performance where peaks can easily hit 110 dBA. Since the dynamic range of my recordings is easily 50 dB plus, there does not seem to be any way to use those published guidelines, since they are based on continuous SPLs, not the huge variations in classical music with only very rare peaks that might constitute a few seconds worth over the course of 15 minutes.

Anyway, the way I am doing it is going by the RMS (average) level. If I have peaks coming out of the headphones of around 104 dB ("c" weighted), then that makes the average level about 81 dB "c" weighted and the soft bits about 50 dB "C"weighted or even less for single instrumental solos.

I think in asking this I am curious about how our hearing copes with non-continuous SPLs as opposed to continuous ones. A layman such as myself would think that the non-continuous SPLs would somehow allow for short recoveries that don't occur with continuous ones.

As a tinnitus sufferer I can't really use the ringing in my ears as a guideline to setting volume levels, since the tinnitus comes and goes as it pleases seemingly at random anyway (actually my tinnitus got worse when I was without any audio gear at all for 4 weeks early this year).
 
May 1, 2008 at 12:08 PM Post #42 of 48
Interesting point ADD, I've always thought the same, setting an adequate, comfortable, and safe level for classical is way more complex than doing so for pop-rock and related styles. It's a matter of recorded dynamic range. Commercial music styles tend to have a very narrow one to allow "flat" volume on any environment and playback equipment.

I don't take any objective measurements as yourself, just set the volume to hear pianissimi with clarity (my guess is about 30dB) and expect the full throttle tutti blasts to be in the worst case at 120dB -provided CD allows 90dB of dynamic range, less for vinyl and FM,- which isn't harmful if they last less than a couple of minutes. If I find them too loud, which happens on very few recordings, then I lower a bit the volume, that's all.

I wouldn't use tinnitus as a guide to set up the volume level, since it can appear immediately, minutes later, or cannot appear at all. Its absence doesn't mean you're using safe listening levels, so you could harm your hearing on the long run despite not suffering tinnitus at the moment of producing the damage. Noise induced hearing loss and associated tinnitus rarely is caused by short duration exposure to very high SPLs, but for habitual long term exposure to higher than safe ones. Listening at 80-85dB on average is loud enough and also safe, there's not much problem for having those increased a bit over 100dB for the short time orchestral blasts last.

I would measure levels using the unweighted SPL dB's. What can damage your hearing is any sound going any higher than what is safe, no matter how loud you hear it. If using weighted dBs, you just account for low and high frequencies measured as you would hear them, not as they really are being delivered, and that's dangerous. You need to know the "real" SPLs at any frequency to set the safe level. Imagine that you're listening to an organ recording with plenty of energy below 100Hz where our hearing is not sensitive. Mesuring on weighted A or C dBs you're correcting the SPL reading to your hearing sensivity, so your measurement would yield a result of let's say 80dB(C) which might seem safe. But the truth is that you'd be exposed to levels of 100 or more dBSPL, which are dangerous if used for more than a few minutes. It's the sound pressure in DaPa what damages the ear, not how loud you perceive it, nor how it measures in weighted dBs.

It'd be safer using your own perception on the frequencies our ear is most sensitive. Pay attention to horns. If they sound loud and piercing, you're using louder than advisable levels.

Rgrds
 
May 2, 2008 at 12:17 AM Post #43 of 48
Thanks very much for the detailed reply - it is much appreciated. I wasn't sure regarding whether the measurements were more relevant bsed on the SPLs we actually hear versus the actual SPLs coming out of the transducer (which we all know are clearly different). So thanks for clarifying that. It is a pity that accurate meters capable of measuring SPLs unweighted are difficult to come by and - I expect - very expensive too.

I've tried to set my SPLS based on what I might hear in a concert hall and then I subtract a certain amount from that. I stopped going to live concerts becuse the SPLs were just too high from my 12th row seat when 20th century symphonic works were played. So I am absolutely certain I am getting less SPLs than a live concert goer (at least in terms of the Sydney Symphony at the Sydney Opera House concert hall).

I've certainly never experienced the phenomenon of not hearing as well after listening to classical through the headphones - my hearing seems to be precisely the same as when I put them on.

Like you, there is some program material I need to adjust more. For example, I have a Mercury LP of Liszt Hungarian rhapsodies and the louder passages tend to go on a bit more than other works.

Still, I think it is sometimes difficult to adjust SPLs on a good headphone setup because the sound delivery is so completely effortless and to all intents and purposes devoid of the distortion that would plague even the best speakers at these sorts of peak SPLs. I know the orchestral peaks on my setup appear to be as effortless as they are in real life, though as I mentioned I think I am setting my level at least 5 dB lower (or more) than in real life.

It was a bit sobering when I was re-reading the specs on an old favourite speaker of mine (LS35A) and noted that the maximum SPL is nowhere near what my headphones are capable of.

Just back on the subject of weighted versus unweighted SPL, I have never quite understood why all the industrial guidelines use "A" weightings, because as you have pointed out - that is just how the meter measures them - it's not what is actually hitting the eardrum. Apparently after talking to an acoustic expert, measurements are taken in octave bands using these "A" weightings. I suppose if you are able to segregate the measurements into octave bands, it does not matter as much, since it is much easier to know whether, for example, a certain "A" weighted SPL at 20 - 40 Hz is dangerous versus an unweighted figure at those frequencies. But if you just do a broadband analysis across the whole frequency range of the measuring device in one hit (which appears to be the limit of the capabilities of these consumer meters) then the figures - as you say - are arguably close to meaningless in many situations.

BTW, I have found my HD25 headphones superb for computer gaming for two reasons. One is the superb isolation from the computer noise, the other is that I can set the SPLs insanely low and still get excellent clarity (sibilance for music listening at normal levels translates to superb clarity for computer gaming at insanely whisper quiet listening levels). I reckon anyone who likes computer gaming and wants to save their hearing - the HD25 is the one IMHO.
 
May 2, 2008 at 1:22 AM Post #44 of 48
You're very welcome mate.

The weighted dB curves were created to measure "disturbing noise" or "sound pollution" so they're more useful to know if the noise from traffic, factories, railways, etc. would be heard and could disturb the people living around the source, than to determine harmful exposure. That's why they are calculated taking into account the different sensivity of human ear depending on frequency. Also this explains that when audio gear manufacturers offer their measurements of SNR they prefer doing it on dB(A). It's always more favourable to get high values, since frequently noise comes from PS hums that appear at 50-60 Hz depending on your country.

If I recall correctly, the A curve is more useful for sounds below 90 or 95dB and the C curve for sounds above that limit and it's more similar to a pure dB SPL curve. Other curves were used to take into account FM performance and Dolby filters in the cassette era. None of these measure the real pressure level, so disregard the true potential harm of the measured noise, specially at low frequencies, which is not negligible.

Accurate SPL sonometers are very expensive. They need very flat measuring microphones with a huge dynamic linearity. Just one of those mics can cost more than 2500 USD. They also need to be frequently re-calibrated.

I agree on your findings about the headphones sounding more effortless showing dynamic swings on well recorded (dynamically uncompressed) music. I think it's mainly for two factors, one of them sensivity, the other noise isolation. Using a transductor right in front your ear that is capable of 94 to 115 dB with just 1mW of power, is something that only very high sensivity loudspeakers (mostly horns) can match. With such sensivities any minute voltage change following the recorded signal can be converted into a change in sound.
OTOH isolation allows you to listen better the lowest sounds, so you don't need to increase the volume to hear them, and when a loud sound happens, there's dynamic headroom enough to preserve the relative scale. This is hard to match for most speakers. Using them even on silent environments, you wouldn't be able to listen at 10-20 dB what was recorded at that level, you more likely would be using 40dB. This means that when a sudden loud event happens, your 90dB headroom would require your speakers (and family and neighbours) to stand a 130dB sound. Very few speakers can play that loud, forget to do so without noticeable distortion. Add also the fact that having an average domestic loudspeaker (let's suppose 89dB/w/m) playing that loud, would require an amp capable to deliver more than 1000wpc, and that listening at 1m from the speakers
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Compared to this, headphones can allow you to play 10dB sounds at 20dB so when that same dynamic swing happens, the loudest would be 110dB, which is well into their available range, reproduction is decently distortion free, and you're not asking huge power delivery to your amp, probably about 1mW, perhaps 64mW if using low sensivity cans.

Returning to the safe levels issue, I've found this graph for you at Wiki:

400px-Lindos2.svg.png


If your soundmeter allows C weighted measurements, use it since it's closer to the SPL curve. Just make your "measurement" CD. Create a frequency swept from 20Hz to 20KHz, let's say along 30 seconds and logarithmic if possible, at 0dBFS (the maximum intensity in a digital signal). Add another track of pink noise at 0dB FS too. No music would sound louder than that. Adjust the volume pot of your amp to have your meter reading the loudest you'd like to listen, let's say 100dB or 110dB, which is still safe for a less than one minute "fortissimo". That's the highest pot mark you should use with well recorded classical.
Repeat the reading and pot adjustment for 85-90dB. That's the level you should use for safe long listening sessions to "commercial" music, which we suppose heavily dinamically compressed.

You can repeat those settings and measurements for your different phones, so you'd know what volume setting to use safely with each of them.

Rgrds
 
May 2, 2008 at 6:45 AM Post #45 of 48
Interesting tests to try, but pretty difficult on consumer level equipment owing to the relatively poor levels of precision in terms of measurement, etc. Plus it is probably torture on headphones pushing out such sustained high SPLs.

I did try them however and actually got a result that measured almost precisely to my earlier subjective estimates. On a 20 hz to 20 khz tone sweep recorded at 0dBFS (with the amp volume set to my standard listening level for classical), I measured output at the headphone ("c" weighted) of between 101 and 106 dB, with a drop in the higher frequencies (that seemed to follow the "C" weighting to a certain extent). There were a couple of acoustic resonance points of the PXC350 drivers - one low frequency and one very high frequency where the meter hit around 108 dB (the meter could of course also have contributed to this) - just for a fraction of a second. But most of the time it was between 101 and 104.

So with an RMS level in the typical classical program of anywhere between -23 dB and -26dB, that equates quite closely to the low 80s average level and probably around 40 dB for the quiet bits, assuming the program material peaks use all the digital headroom available.

When I actually tested music material, in all cases it never peaked anywhere near 106 - more like 101 at the absolute most. Obviously this is because the chances of real music hitting all the most sensitive frequencies at the same time is incrediby remote, though theoretically possible.

Anyway, even allowing for the vague level of accuracy in the above test, I sort of feel better knowing that the listening levels don't seem like they would be damaging in any way, especially given that I limit that sort of listening to around 45 minutes maximum 6 days per week.

Tried it also on my HD25 phones connected to my gaming rig. The peaks barely registered on the meter, just breaking the 50 dB "C" weighted barrier. Such is the clarity of those phones at extremely low listening levels (but I find them completely and utterly useless for music).
 

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