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[I have] noise induced tinnitus and no hearing loss, but should I expect some in the future?

This is a question from my Quora mailbag, and my answer is as follows:

If your tinnitus was definitely caused by excessive noise, then it is a symptom of damage to your hearing system and yes, you would be at a greater risk of hearing loss. However, it is very difficult to predict when and how much!

What we can sometimes see is people who have been exposed to noise have no hearing loss showing up on their audiogram (hearing test results), or average hearing loss for their age, but it is different to the typical age related hearing loss. It may be greater, or progress more quickly than average. They may have greater than expected difficulty distinguishing speech in the presence of background noise. One of my more recent tinnitus patients who worked in a factory had a mild loss at age 48, but severe tinnitus and difficulty hearing in pubs etc, more difficulty than I’d expect from the audiogram alone. This is often called “Hidden Hearing Loss” for obvious reasons.

Hearing loss (age-related, also called presbycusis) usually gets progressively worse on the audiogram from low frequency (pitch) to high frequency. If you’re over 55, a loss shaped like this would be considered normal, caused by wear and tear.

With people who worked/work in noisy environments for a long time without hearing protection, their audiograms often show visible loss at an earlier age than expected, sometimes with the telltale ‘tick’ on their graph.

With noise induced loss, the 4kHz region is worst affected, then the hearing rebounds and 8kHz is better than 4kHz. This produces the tick shape on the audiogram and is caused by the physics of the ear canal. Human ears amplify sound at around 4kHz because that is the resonant frequency of the ear canal (sound gets a natural boost in volume at that specific frequency due to the shape and size of the ear canal). People who work in noise have a constant damaging level of noise, and their ears are constantly amplifying most efficiently at 4kHz. I see this quite a lot as I work in a mill town with many older people who spent their working lives in mills or factories.

With milder cases, or early on in the process, that tick might not be there but the hidden hearing loss either has started or will come. All sorts of factors are in play here though, from exposure time/type to individual genetics. It would be impossible to say how any one individual might be affected.

Tinnitus has many different causes, but roughly 80% of those with tinnitus also have hearing damage, be it ‘hidden’ or not. Tinnitus is frequently the first sign you notice that your hearing is not as good as it once was. If you haven’t already done so, see an audiologist to get your hearing tested and check the tinnitus doesn’t need any medical intervention or testing.

The best course of action then, is to protect your hearing as best you can to limit any hearing loss. If you work (or play!) in unavoidable noise, use hearing protection. You can look up and learn safe exposure volumes and times. A rule of thumb when out at a bar, for instance, if you’re having to shout to be heard over the noise it’s too loud. Phone apps, though not 100% accurate, can give you a very good indicator of noise level.

I realise this is not a very encouraging answer, but it’s important for readers to understand that they aren’t necessarily “getting away with it” just because they don’t have a loss showing on their audiogram yet. You should also know that audiologists can help you if the time comes that you need help, so don’t worry about what may happen, just reduce any further noise exposure as best you can. Noise-induced hearing loss is cumulative, so even if you’ve already damaged your hearing, there is every reason to start looking after it now.

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