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.
When hyperacusis develops:
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.
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:
Therapy involves a range of auditory, psychological and perceptual hyperacusis management and desensitisation strategies:
Guidance is provided on effective treatment of TTS symptoms.
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: