Hyperacusis is a condition in which someone experiences an abnormal intolerance, pain and/or negative emotional reaction to sounds with specific characteristics, such as a particular volume or pitch.
“Hyper” simply implies excessive, and “acusis” represents sound.
These sounds can result in annoyance, fear or even physical discomfort and pain, even at low volume levels that others think are normal. It’s similar to, but not the same as phonophobia or misophonia, which is fear of a specific sound or sound patterns. It can occur alongside tinnitus, hearing loss, phonophobia, or misophonia, or it can occur independent of any other hearing condition.
Hyperacusis can negatively affect quality of life. It can lead to social isolation, anxiety, depression, lack of concentration, and insomnia. Many times people with hyperacusis live with anxiety and fear. If you add on the frustration caused by the lack of understanding of the condition by medical professionals, the condition can escalate.
Information about the cause of hyperacusis is limited. The condition is not well understood by many professionals, even hearing healthcare professionals. Getting help can be very frustrating and often times someone will go to 4 or 5 doctors for help before it is properly addressed.
What We Know About Hyperacusis
There are several theories about the cause of hyperacusis. It is most commonly associated with long-term noise exposure, or an acoustic shock incident in which the individual was exposed to an unexpected and threatening loud noise that triggered an emotional reaction. It has also been linked to other conditions such as autism, migraine, Williams syndrome, Addison’s disease, Bell’s palsy, depression, Lyme disease, physical trauma to the head or infections of the inner ear.
People with hyperacusis can experience physical pain in the ear in response to certain sound levels, even if the sound is at a low to moderate volume level. This is sometimes described as a a sharp or dull pain in the ear, jaw, or neck, feeling of fullness in the ear, or a tingling in the ear.
This pain response has been linked to increased activity of the tensor tympani muscle in those with hyperacusis. When a certain sound level is perceived, the tensor tympani muscle tightens and pulls on the eardrum leading to pain in the ear. This abnormal tensor tympani reflex is known as tonic tensor tympani syndrome (TTTS) and may be the underlying cause of hyperacusis following an acoustic incident trigger.
Loudness hyperacusis can be assessed by an Audiologist by measuring the person’s loudness discomfort levels (LDL) and performing a loudness growth assessment in a sound booth. Specifically designed questionnaires are also useful in determining the emotional impact of annoyance and fear hyperacusis on the person. The Multiple-Activity Scale for Hyperacusis, for example, calculates an average annoyance score to help diagnose the severity of annoyance hyperacusis.
If hyperacusis is suspected, it is important to determine whether the person is experiencing loudness discomfort (loudness hyperacusis), an emotional reaction or avoidance of certain environments or situations (annoyance or fear hyperacusis) or a physical discomfort in response to low sound levels (pain hyperacusis). In some cases, the person may experience all three. This information will better help guide the course of treatment.
Help for Hyperacusis
At the present time, there is no cure for hyperacusis. But, that doesn’t mean there is no hope. Currently, there are multiple theories regarding the best treatment method for hyperacusis. Often times it is a combination of methods that is most helpful in managing hyperacusis.
Successful sound therapy methods aim to desensitize the person to triggering sounds. One adopted method involves exposure to low-level broadband noises with the use of an in-ear sound generator device. Other sound therapy methods may include carefully prescribed introduction of the specific environmental sound that is bothersome instead of using broadband noise. Introduction of sound usually begins below the person’s tolerable sound level and is then gradually increased over time to increase tolerance.
Similarly to tinnitus, hyperacusis can have a negative impact on a person’s well-being, and it is important to address their psychological issues in an understanding and encouraging manner. Counseling methods for hyperacusis include helping the person understand their condition and its triggers.
Hyperacusis Activities Treatment
Since tinnitus and hyperacusis often go hand in hand, many of the treatment methods for hyperacusis are adopted from tinnitus treatments. The Hyperacusis Activities Treatment is modeled after the Tinnitus Activities Treatment. It is a counseling method that combines both counseling components that focus on the person’s reaction to a sound, as well as a sound therapy component.
In social support counseling, the person with hyperacusis is encouraged to enter a problematic environment with the support of their trusted counselor who will accompany them. This may help to decrease the anxiety associated with annoyance and fear hyperacusis.
Cognitive Behavioral Therapy (CBT)
This is another hyperacusis treatment method that was adopted from tinnitus treatment. It involves education, relaxation training, specifically prescribed exposure to sounds, and cognitive therapy to reduce stress and beliefs associated with hearing certain sounds.
Use of Earplugs
The use of hearing protection in treating hyperacusis is a controversial topic. Some believe that the use of earplugs will only escalate hyperacusis symptoms once the earplugs are removed. However, many people with hyperacusis wear earplugs in situations they believe will be bothersome. The use of active earplugs (which lower high volume sounds that could be harmful while not lowering low volume sounds) may be helpful for people with hyperacusis.
Although there are currently no clinical trials done on medication treatments for hyperacusis, a few case studies have been reported which look promising for the future.
Where to Get Help
Many times people with hyperacusis will go to their primary care physician for answers. While some general practitioners may be aware of hyperacusis, they will likely not know what to do about it. Referral to an ENT or an Audiologist who specialized in tinnitus and/or hyperacusis should be the next step when it comes to the diagnosis and treatment of hyperacusis.
There are professionals who have experience and success at managing people with hyperacusis. For more information and resources on hyperacusis, you can visit The Hyperacusis Network or find an Audiologist near you at The American Academy of Audiology.