Ear plugs: fer 'em or agin 'em

A good way to get a lively discussion going with a doctor is to request he write a prescription for ear filters for a person with mild traumatic brain injury. Often the reaction is pretty dramatic. "You're going to make her dependent on ear plugs! She just needs to improve her tolerance for noise!"

I think this approach fails to take in to consideration the effect of over-stimulation on a person with mild traumatic brain injury and how it limits his or her ability to re-engage with the world. It's true that some people are naturally more sensitive to noise than others. As I mentioned in the previous post, we depend upon the brain to adjust to auditory input so that it is tolerable; otherwise we'd never venture into a busy restaurant or a football stadium.

But when a person has a mild traumatic brain injury, noise is more than just annoying. It can be painful. It can cause extreme anxiety. And this happens all the time: when driving, in the classroom, when working on the computer ("I can hear the sound of the drive. It's so distracting. I've developed hearing like a dog!").

So, here's the deal. Of course the eventual goal is to help a person improve tolerance for noise. But, at first, I think we have to reduce input to the brain while it heals. Otherwise too much effort will be expended trying to react to the stimulation. The result is anxiety and avoidance of certain places and situation. I'm pretty sure it interferes with healing. When we fit a person with ear filters, they report an immediate reduction in anxiety. They are able to go out in public again. Teachers report that the noise in the classroom no longer drives them crazy. I always suggest that people try to go without the filters sometimes to gradually increase their tolerance for noise. Since people generally would prefer not to have to wear them, they go along with this plan.

I like the product made by Westone. They make a custom fitted ear filter with various degrees of protection: 8 dB for low level ambient noise; 15 dB for places like stores, restaurants; 25 dB for situations where people really need most distracting noise reduced, and "total blocks" for sleep (I use these -- I can hear really important sounds but no longer am awakened by cars going by on the street: a left over from the days my kids were out past my bedtime). They're called "musicians earplugs" or "defend ears" and, yes, "normal" people use them to reduce auditory input.

The downside: they have to be individually molded by a technician and they can get pricey. But, I have been able to convince some insurance companies to cover the cost when I explain how effective the ear filters are.

Worth it? A lot of clients would say emphatically "YES".