The word “hyperacusis” literally means excess hearing. The name combines the Greek prefix “hyper” means “over,” implying excess or exaggeration with “akousis,” which means hearing and is the root word of “acoustic.”

Hyperacusis is a life-altering hearing condition that causes one to experience loudness intolerance or increased sensitivity to noise. It’s typically a condition that someone is not born with but develops, either gradually or suddenly, as a result of the following causes, per the American Academy of Otolaryngology–Head and Neck Surgery:

  Credit: Getty Images

Credit: Getty Images

  • •Head injury
  • Ear damage from toxins or medication
  • Lyme disease
  • Air bag deployment
  • Viral infections involving the inner ear or facial nerve (Bell’s palsy)
  • Temporomandibular joint (TMJ) syndrome

Hyperacusis affects an estimated one in 50,000 people and can occur either unilaterally (in one ear) or bilaterally (in both ears). Reactions to noise may result in feelings of discomfort, covering ears, tension, anger, anxiety, and pain.

Those who live with hyperacusis face aversion to everyday sounds at decibel levels that do not bother others, such as: running water, car engines, conversations, kitchen appliances, voices speaking on the telephone, bicycle pedals, crunching leaves, or vacuum cleaners.

Because individuals with hyperacusis are not able to tolerate noises like those listed above, their quality of life is compromised. They experience great difficulty moving about, traveling, and communicating with others. Consequences can include social isolation, anxiety, depression, lack of concentration, and insomnia.

Hyperacusis is distinct from tinnitus (ringing in the ears), but there is a high degree of comorbidity between them. An estimated 86% of hyperacusis patients also have tinnitus and 30–40% of tinnitus patients also show symptoms of hyperacusis. It has been speculated that tinnitus and hyperacusis have a shared etiology or might exist due to the same pathological mechanism.

Sources: American Academy of Otolaryngology–Head and Neck Surgery; Hyperacusis Network; National Health ServiceFrontiers in Neurology

  Credit:  woodleywonderworks , Flickr

Credit: woodleywonderworks, Flickr

Richard S. Tyler, Ph.D., professor of communication sciences and disorders and of otolaryngology at the University of Iowa, describes four categories of hyperacusis: loudness, annoyance, fear, and pain. While he sees all of these subtypes intersecting in the clinic, epidemiological data on hyperacusis are lacking, “so it's hard to know how much overlap actually occurs,” he said.

  • Loudness hyperacusis: moderately intense sounds are perceived as too loud

  • Annoyance hyperacusis: a negative emotional reaction to sounds

  • Pain hyperacusis: a stabbing sensation at much lower sound levels than would typically prompt pain. 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 according to Lindsey Banks, Au.D.

  • Fear hyperacusis: a negative response to sounds that may cause patients to avoid social situations or feel anxiety in anticipation of hearing these sounds

Dr. Tyler explains that one type of hyperacusis may lead to another. “If you experience loudness hyperacusis, emotional consequences may follow, leading to stress and annoyance, which eventually lead to fear of going to events and socializing,” he said. “Pain is a little more complicated because it consists of both a fundamental attribute and an emotional consequence.”

Source: The Hearing Journal; Everyday Hearing

Presently, there are no specific surgical or medical treatments for hyperacusis. However, a number of techniques exist to help individuals better manage hyperacusis. Many of them mirror the treatments used for tinnitus.

Sound Therapy is used to retrain the brain to accept everyday sounds. This involves the use of a noise-generating device worn on the affected ear or ears for at least two hours a day. To ensure comfort for the patient, the device produces a gentle static-like sound (white noise or broadband noise) that is barely audible. Completion of sound therapy may take up to 12 months, and usually improves sound tolerance. Sound therapy may additionally 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.

Cognitive Behavioral Therapy (CBT) is used for hyperacusis in addition to depression, anxiety, post-traumatic stress disorder, and other conditions. It focuses on restructuring the negative reactions toward and regaining control over the condition. Adopted from tinnitus treatment, CBT for hyperacusis involves education, relaxation training, specifically prescribed exposure to sounds, and cognitive therapy to reduce stress and beliefs associated with hearing certain sounds.

With Hyperacusis Activities Treatment, the patient’s goal is to be able to recognize the relationship between the loudness of a sound and his or her reaction to it. The counseling components include: thoughts and emotions, hearing and communication, sleep, and concentration.

Hearing Protection can be worn to mitigate the discomfort of hyperacusis. There are many types including foam earplugs, silicone or putty types, custom earplugs that are shaped to fit to the ear, and over-the-head ear muffs. 

Sources: American Academy of Otolaryngology–Head and Neck SurgeryEveryday Hearing; Hyperacusis Network; Hyperacusis Focus 

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