These shows were expensive to produce, however, and while they earned the band a reputation for being one of the most entertaining live acts of the time, by the early 1980s, they'd left the band in debt to A&M Records, even after they'd sold their song rights for tour support. This suggests that anxiety can significantly influence TTTS symptoms but that it cannot be used as a blanket explanation. Comments on TTTS Arrestguieta L, Acuna L, Ortiz G. Tensor veli palatini and tensor tympani muscles: Anatomical, functional and symptomatic links. Acta Otorrinolaringologica Espanola 2010:61:26-33. There are claims from those who focus on TTTS research that pain hyperacusis is not just influenced by anxiety but is actually caused by anxiety. Supporting evidence for this claim was not presented. Many with hyperacusis make clear that anxiety develops after tolerance levels have already dropped. The multi-clinic prevalence study by Westcott et. al can be found here. In-Depth: Relation to Eustachian Tube Dysfunction, Anxiety, Comments

If you don’t fancy peering closely at a map trying to compare the prices across London, here’s the basic info: Tyler R, Pienkowski M, et. al. A Review of Hyperacusis and Future Directions: Part I. Definitions and Manifestations. American Journal of Audiology 2014:23:402-419.

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Anxiety and emotional state can play a role in TTTS. Both middle-ear muscles receive direct control from centers of the brain that are influenced by emotional state (the serotonergic system) (McFerran 2007). This along with clinical experience leads some researchers to report that TTTS symptoms can be reduced or eliminated once sound tolerances improve and anxiety to protect one’s ears is reduced. Create gorgeous tags with our brand-new With Love Tag Die Set! This highly versatile die set contains everything you need to make a selection of lovely, gift tags. Several TTTS symptoms such as aural fullness and changes in ventilation are related to the eustachian tube. The eustachian tube is a passageway that connects the upper part of the throat to the middle ear cavity. This tube normally remains closed to prevent bacteria from the throat from traveling to the middle ear, reduce pressure fluctuations, and reduce loudness from self generated sounds. This tube occasionally opens to equalize pressure changes and prevent fluid build up. It will open when you sneeze, swallow, or yawn. If this tube does not open, pressure builds in the middle ear and sensations of aural fullness develop. How can hyperactivity of the tensor tympani have an impact on the eustachian tube?

Kierner AC, Mayer R, Kirschhofer K. Do the tensor tympani and tensor veli palatini muscles of man form a functional unit? A histochemical investigation of their putative connections. Hearing Research 2002:165:48-52. Westcott M et. al. Tonic tensor tympani syndrome in tinnitus and hyperacusis patients: A multi-clinic prevalence study. Noise & Health 2013:15:117-128. Nonetheless, the prevalence of coinciding TTTS symptoms in hyperacusis patients is important. Those who have developed hyperacusis may find some comfort in having several of their symptoms described as a product of TTTS. Acoustic Reflex and the Stapedius Muscle The 2013 multi-clinic study by Westcott et. al. found that 81% of hyperacusis patients had TTTS. They determined this not by examining for hyperactivity of the tensor tympani but by seeing if one or more unexplained TTTS symptoms was present. Thus, almost any hyperacusis patient with unexplained ear pain would be diagnosed with TTTS. As the fundamental characteristic of those with pain hyperacusis is ear pain, one must be careful to lump this as a side effect of TTTS. It is likely that a hyperactive tensor tympani can cause ear pain but there is a possibility that ear pain independent of TTTS is getting included in this study.