How musicians’ earplugs may be useful in post-concussion syndrome

Post-concussion syndrome is a group of symptoms that can occur for days, weeks, months, or even up to a year or two after a head injury.  It is considered to be a mild form of traumatic brain injury and about 1 in 6 people experience this after a concussion.  The etiology and physiology is not well understood. There really is no direct treatment of post-concussion syndrome and a combination of cognitive therapy, and just “plain old time” are two approaches.

People with this syndrome may report dizziness, decreased tolerance to (flickering) light, or a decreased tolerance to sound (hyperacusis). Over the past several years I have been referred more than 10 people with post-concussion syndrome  whom have had complaints of hyperacusis.  While this is a relatively small sample, I have been able to follow these patients closely, as would any of my colleagues who work with hyperacusis.  Indeed some of these patients have been receiving neurological based retraining therapies, such as tinnitus retraining therapy for hyperacusis, with varying degrees of success.

When dealing with hyperacusis (especially post-concussion syndrome related hyperacusis) a “balancing act” is required.  Too much hearing protection or withdrawal from all sound can be problematic, and too little protection can also be problematic.

Definite short term gain can be obtained by allowing these people to continue wearing their maximum protection over the ear “cans”.  Many come to my office wearing these large hearing protection devices.  With these in place, the patients can go into potentially noisy situations with a reduced fear of being bothered by extraneous bangs or pops.  But, this short term gain may result in long term pain- their brain does not have a chance to rewire itself and naturally re-acquire its homeostatic state.  With this strategy, these people will continue to need to wear these maximum hearing protectors for a long time, or more likely, will gradually withdraw from many social situations.

Another strategy (which is just as silly) is to tell them to “grow up” and get back out there- loud noises are not the fiendish devil they make it out to be.  Other than probably having the patient stick their middle finger up at you, there is not really any research to support this view.

The intermediate balance that I have been recommending with some success (emails and phone calls from my patients telling me that this is great) is to use musicians’ earplugs.

Traditional hearing protection reduces the lower frequency region by 15-20 dB but the higher frequency region by up to 35-40 dB.  Subsequently, when communicating, the person would hear speech as if they had a high frequency hearing loss- people’s speech would be mumbled.  In contrast, musicians’ earplugs (and there are now several forms of these from different manufacturers, for example, from Etymotic Research , and Dynamic Ear Company are uniform attenuators that treat all relevant frequencies in the same way.  Sound is reduced by 15 or 20 dB but this is true regardless of whether the sound is low frequency, mid frequency, or high frequency.   The sound is the same, except slightly reduced in sound level.

These musicians’ earplugs should be called “post-concussion earplugs”, but I think that “musicians’ earplugs” probably sound sexier. With these earplugs, patients with post-concussive syndrome can go to social events where now the auditory “edge” has been removed.  These are still not perfect, but by only reducing the environmental sound level 15 or 20 dB, the brain still is given the opportunity to retrain itself and hopefully re-achieve a homeostatic state.

About Marshall Chasin

Marshall Chasin, AuD, is a clinical and research audiologist who has a special interest in the prevention of hearing loss for musicians, as well as the treatment of those who have hearing loss. I have other special interests such as clarinet and karate, but those may come out in the blog over time.