Hyperacusis

What is Hyperacusis?

Hyperacusis is an abnormal sound sensitivity or decreased sound tolerance, with a heightened sense of volume and physical discomfort from many everyday sounds that other people can comfortably tolerate. 

Sounds that are typically difficult for people with hyperacusis to tolerate are loud/impact/sustained sounds, particularly if they are unexpected and in close proximity to the ears.  High frequency (pitch) sounds tend to be tolerated less well.

Hyperacusis most commonly develops when these sounds are subconsciously evaluated in the primeval parts of the brain as potential threats to safety and survival.  This subconscious primeval fear may be due to trauma associations or that these sounds are unsafe because they could cause harm or pain.  More specifically, it is feared that they may cause damage to a vulnerable ear or exacerbate pre-existing aural symptoms such as tinnitus or hearing loss.

Symptoms of Hyperacusis

When hyperacusis develops:

  • everyday sounds begin to appear unnaturally prominent and increasingly louder.
  • loud and sudden sounds, particularly if they are unexpected or close to the ears, may cause:
    • a temporary increase in tinnitus (if present)
    • a temporary increase in sound sensitivity
    • escalating sensations in the ear consistent with TTS such as pain, blockage/popping, a fluttering sensation, muffled hearing
  • This reaction can generalise to include more and more sounds, with escalating sound-induced TTS symptoms. 
  • As a result, people may come to believe that their ears are no longer able to physically tolerate these sounds.  They may believe that these sounds are causing damage to their ears or hearing and should be avoided. 
  • The combined effects of:
    • the escalating anxiety/panic, distress and bewilderment
    • the escalating sound-induced physical discomfort
    • and the inevitable auditory hypervigilance – all can lead to hyperacusis escalation. 

Hyperacusis can range from mild through to severe to extreme.  The cluster of physical symptoms consistent with TTS that are induced by intolerable sounds can also range from mild to severe to extreme – with sound-induced pain at the severe end of the spectrum.  Often, but not always, the more severe the hyperacusis, the more severe the sound-induced TTS symptoms become.

What can cause Hyperacusis?

Severe tinnitus.  The most common trigger for hyperacusis development is a subconscious evaluation that loud sounds will potentially exacerbate tinnitus.  The consensus is that about 40% of people with troublesome tinnitus have some degree of hyperacusis.  Large-scale prevalence research, including research carried out at our clinic, has identified the development of secondary hyperacusis in about 50% of help-seeking tinnitus patients.

Acoustic shock is another common factor predisposing towards the development of hyperacusis.  If acoustic shock symptoms persist after the acoustic incident, it is generally because hyperacusis has developed.

Misophonia can predispose towards hyperacusis development.

Hyperacusis can also develop with:

  • high levels of health-related anxiety
  • abrupt changes in hearing: sudden onset hearing loss, Meniere’s Disease, perilymph fistula, Bell’s Palsy.  In rare cases, the amplification from newly fitted hearing aids can lead to hyperacusis.
  • superior semicircular canal dehiscence causes a heightened perception of internal bodily sounds, often described as hyperacusis
  • neurological injuries and disorders affecting the central auditory pathway, including head injury, post concussion syndrome
  • autism: children with autism have an increased risk of developing misophonia and consequently hyperacusis
  • myalgic encephalomyelitis (chronic fatigue syndrome), fibromyalgia, Lyme disease

Treatment for Hyperacusis

Therapy involves a range of auditory, psychological and perceptual hyperacusis management and desensitisation strategies:

  • Understanding the peripheral and central auditory pathway, including the mechanisms of hyperacusis and obtaining a personalised explanation of TTS
  • Examination of your thoughts and beliefs about your hyperacusis and associated physical symptoms – you may need to be open to accepting a new perspective
  • Management of hypervigilance towards the auditory environment and your TTS symptoms 
  • Gentle, safe sound enrichment strategies.  This includes the creation of a portable “safe space”, using sound as a shield from intolerable sounds and to allow detachment from an unsafe environment.
  • Advice on the use of earplugs, including hearing aids set up as electronic filters

Guidance is provided on effective treatment of TTS symptoms.

FAQs

When hyperacusis develops, loud/impact everyday sounds begin to appear unnaturally prominent and increasingly louder. 

Following exposure to these sounds, a temporary increase in tinnitus (if present) and/or hyperacusis may be noticed, and escalating sensations in the ear may develop due to TTS, such as ear pain, a fluttering sensation or fullness/blockage in the ear.  

Hyperacusis desensitisation is achievable.  For many people, an explanation, accurate understanding of the mechanisms and reassurance can make a big difference.  This is an essential starting point.  Effective treatment of TTS symptoms is needed.  Proactive self-management using the above strategies can promote successful hyperacusis desensitisation. 

However, the factors resulting in hyperacusis are complex and outside a patient’s conscious control, so it is impossible to predict how long hyperacusis will last and desensitisation may not always be achievable.

Significant hyperacusis can cause anxiety, distress, suffering from sound-induced pain and lifestyle constraints. 

Hyperacusis can be considered a disability for people affected by their hyperacusis in this way.

Desensitisation requires a personalised understanding of the mechanisms behind the development of hyperacusis and TTS, such as:

  • effective treatment of sound-induced pain
  • belief in the prospect of change
  • management of auditory hyper-vigilance
  • the use of sound enrichment
  • the judicious use of ear protection.

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