Acoustic Shock by Nail Gun

Acoustic shock (AS) is a rare condition caused by an unexpected loud sound and resulting in a number of otologic symptoms, including otalgia without physical findings, tinnitus, hyperacusis, mild dizziness, and, in some cases, tonic tenor tympani syndrome and trigeminal nerve irritability (Wescott. Noise Health 2013; 15[63]:117-128). Acoustic shock is a life-changing disorder with a significant psychogenic component (Hooper. J Laryngol Otol 2014;128[Suppl 2]:S2-9). People suffering from AS often stop working, retreat into isolation, and use hearing protection insidiously, as they fear everyday sound. What appears initially to be a complaint of peripheral hearing loss and tinnitus is actually much more extensive, as the central auditory structures and the limbic system become engaged and the patient’s behavior changes.

According to Lin et al., neuropathic changes to the cochlear nerve peripheral terminals and a slow degeneration of spiral ganglion cells occur in animals that are acoustically overstimulated, even in the absence of inner or outer hair cell loss, with the recovery of hearing thresholds (Lin. J Assoc Res Otolaryngol 2011;12[5]:605–616).