"Then his boss was looming, her face close to his, her mouth moving but nothing coming out, no words, no sounds. And still the enormous pressure, now pushing against his ears, as if he were underwater. And a terrible inexplicable shrieking that he finally realised was coming from inside his own head."
Acoustic Shock Disorder can be triggered initially by a wide range of sounds such as, a starter pistol; a threatening voice at close range during an assault; metal hammering on metal; loud machinery; an unexpected blow to the ear or head; glass crashing; a public toilet hand dryer. While critically Westcott says the volume of the noise is a factor, the common link is that the sounds are unexpected and startling. Another is the presence of TTTS (Tonic Tensor Tympani Syndrome - a startle reflex)
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Kate Cole-Adams, Journalist and published in the Monthly, May edition 2018. Myriam Wescott is an independent Audiologist in Private Practice who specialises in Tinnitus, Hypercusis and Acoustic Shock. She co-authored a paper with Alison Chiam which won the panel selected Ted Vernon Prize at the International Tinnitus Seminar, Brazil. It was this work which is key to our understanding of how sound causes pain.