Hyperacusis

What is Hyperacusis?

Hyperacusis is an abnormal sound sensitivity or decreased sound tolerance, with a heightened sense of volume and physical discomfort from 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 is the consequence of an involuntary sense of threat triggered by those sounds when they are subconsciously processed, often due to those sounds being evaluated as potentially damaging or potentially painful or potentially exacerbating 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 such as pain, blockage/popping, a fluttering sensation, muffled hearing
  • This reaction can generalise to include more and more sounds. 
  • As a result, people may come to believe that their ears are no longer able to physically tolerate these sounds or that these sounds are causing damage to their ears or hearing and should be avoided. 
  • The anxiety about the effects of exposure to these sounds and the resultant emotional reaction (eg panic/distress) can lead to hyperacusis escalation. 

What can cause Hyperacusis?

Pre-existing tinnitus and acoustic shock are the most common factors that predispose towards the development of hyperacusis. 

The consensus is that about 40% of people with troublesome tinnitus have some degree of hyperacusis.  Recent 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.

If acoustic shock symptoms persist after the acoustic incident, it is generally because hyperacusis has developed.

Misophonia and high levels of anxiety can predispose towards hyperacusis development.

Hyperacusis can also develop with:

  • a number of conditions affecting the auditory pathway – including Meniere’s Disease, otosclerosis, perilymph fistula, Bell’s Palsy
  • neurological injuries and disorders affecting auditory processing – including head injury, brain damage, migraine
  • adverse reactions to some medications
  • psychiatric disorders
  • autistic spectrum disorders
  • chronic fatigue syndrome
  • fibromyalgia
  • Lyme Disease.

Treatment for Hyperacusis

  • Understanding the peripheral and central auditory pathway, including the mechanisms of hyperacusis and obtaining a personalised explanation of TTTS
  • Examination of your thoughts and beliefs about your hyperacusis – you may need to be open to accepting a new perspective
  • Management of hypervigilance towards the auditory environment and your TTTS symptoms. 
  • Sound enrichment strategies, including the creation of a “safe space” where sound enrichment strategies can be used to create an “auditory bubble” providing a cocoon to shield from trigger sounds and detachment from the environment.
  • Advice on the use of earplugs, including hearing aids set up as electronic filters

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 TTTS, such as ear pain, a fluttering sensation or fullness/blockage in the ear.  

For many people, explanation and reassurance will allow them to desensitise their hyperacusis successfully. 

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 TTTS, 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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