Many people have misunderstandings about tinnitus, hyperacusis, and recruitment. These two conditions can significantly affect the results of tinnitus relief therapy, especially when tinnitus sufferers and their helpers are unaware of them. When you have what's often called "clean" tinnitus, it can create various issues for the person experiencing it, particularly because it triggers strong negative emotions like anxiety and fear. If you add recruitment or hyperacusis into the mix, tinnitus sufferers experience even more difficulties. If the same individual also has hearing loss, it becomes a highly complicated problem that not many healthcare professionals can effectively address. An average tinnitus sufferer struggles to manage all these issues by themselves, regardless of the numerous resources available on the internet, including masking sounds and other remedies, such as working with their ears or eustachian tubes, among other things. So, to learn how to help ourselves in this situation or what the proper working solution should be, we need to understand what recruitment and hyperacusis are all about.

People often tend to oversimplify the idea of recruitment by suggesting that when someone with hearing loss experiences hyperacusis, it automatically means they have "recruitment." Some individuals dealing with severe hyperacusis claim their condition is so extreme that they must also have recruitment. However, it's crucial to understand that recruitment and hyperacusis are quite distinct, and it's essential to understand this difference, especially when discussing tinnitus and hearing loss.

We believe having a clear understanding of these terms is very important. For those dealing with tinnitus, it's even more crucial to know how different it is between managing "clean" tinnitus without any other issues or conditions and dealing with tinnitus alongside recruitment or hyperacusis, especially when hearing loss is also in the picture, bringing with it a host of additional challenges. To help you understand what we are discussing, we should explain what recruitment and hyperacusis are and how they affect tinnitus symptoms.

1) Hyperacusis is a decreased threshold to discomfort from sound. It can range from a person who is mildly uncomfortable in a restaurant where all the other people at the same table have no discomfort to someone who experiences extreme discomfort from everyday sounds to the point where they can't even leave their bedroom or home because of it. Some people with extreme hyperacusis cannot take earmuffs away from their ears. Sounds, even ordinary sounds, can be so painful that they are experiencing pain in their ears with very frequent panic or anxiety attacks. We know that hyperacusis is an abnormal change in how we perceive sounds, dominated by the brain's efforts to compensate, and it's different from loudness recruitment.

Hyperacusis almost always involves the limbic system's abnormal activation, accompanied by high levels of anxiety and extremely high levels of fear and aversion to practically any sounds. There's a strong hyperacusis-tinnitus correlation. Even though hyperacusis is not so common, people with tinnitus frequently experience hyperacusis. It's estimated that around two-thirds of individuals with tinnitus experience some level of hyperacusis. Research findings confirm that more than 40% of tinnitus sufferers experience problems with tolerance and reactions to loud or even louder sounds in their listening environments. So called category four tinnitus describes all tinnitus sufferers who will experience tinnitus symptoms worsening due to the exposure of louder or loud sounds for a longer time. This is also why there are so many people having severe difficulties with hearing aids programmed using strong masking sound or even hearing aids with maximum sound output levels set too high.

2) Recruitment is the rapid growth of perceived loudness for those sounds located in the pitch region of a hearing loss. (This is Jack Vernon's definition.) So, to illustrate this concept, consider a familiar example. Let's say my father has a significant hearing loss. I call out, "Dad," but he hears nothing and doesn't respond. I try saying it a bit louder, but still no response. I increased the volume a bit more, but there's still no reaction. Finally, I speak it just a tiny bit louder, and he responds with, "Stop yelling so loudly, I hear you just fine. Please lower your voice a bit!" That's an example of recruitment in action. This is recruitment, in simple terms, when the perceived loudness of sounds in a specific pitch range increases rapidly within the area of hearing impairment. It's a situation where the difference between a comfortably loud sound and a painfully loud one can be very slight. One common challenge when dealing with people who have recruitment is conveying to someone with significant hearing loss that the moment when my voice becomes uncomfortable for their ears was actually the fourth time I attempted to get their attention.

So, recruitment causes your perception of sound to be exaggerated. Even though there is only a small increase in the noise levels, sound may seem much louder, which can distort and cause discomfort. Someone with recruitment can have problems only with specific sounds and frequencies or may have problems with all sounds in general. The main difference between hyperacusis and recruitment lies in this: Hyperacusis affects people whether or not they have any hearing loss that can be detected through a standard hearing test.

Auditory impairments include various conditions. There's the well-known hearing loss, which involves an elevated threshold for sound detection. Then there's tinnitus, which is the perception of sound in the ears without any external sound stimulation. Hyperacusis can affect people by making them extremely sensitive to certain sounds. Finally, there's loudness recruitment, which only affects some people with hearing loss. It narrows the range between when they can detect a sound and when it becomes painfully loud.

Treating tinnitus with hyperacusis can be challenging but achievable. However, dealing with a tinnitus sufferer with hearing loss and recruitment becomes an exceptionally tough task, demanding a high level of expertise, knowledge, and experience. In both scenarios, individuals often experience elevated anxiety levels and, in some cases, even frequent panic attacks, which can significantly impact the treatment process. As conducted in professional tinnitus treatment clinics, the aspect of decreased sound tolerance should be the most crucial element in proper assessments, evaluations, and treatment protocols. Then again, how many of you can say that the LDL test was performed and the results were explained to you in the hearing clinic where you went to have your so-called tinnitus assessment? Not that many.

So, suppose you're dealing with the combination of hyperacusis and tinnitus, even with high levels of anxiety, especially if there's hearing loss. In that case, we want to emphasize that there is a very significant chance for successful treatment and elimination of all symptoms. This becomes possible when you undergo treatment that integrates all the necessary therapies provided by experienced professionals in one of the many professional tinnitus treatment clinics.

This highlights the importance of choosing only truly professional tinnitus treatment clinics – with highly skilled professionals and well-prepared experts capable of addressing complex tinnitus case.