“Patients with hyperacusis are some of my most challenging patients. The causes and treatment may be more like figuring out a medical ‘whodunit.’ I cannot stress enough to patients that they need a full ENT and audiologic evaluation to determine the cause, in order to find some solutions.” - Drew Sutton, MD, Board-Certified Otolaryngologist
Hearing consists of a complex interplay between your ears and your mind. Your ears send the signals to the brain, and your brain then interprets those signals and provides you with all the necessary information you need.
This complexity allows people to quickly discern sounds within the environment but also opens up the possibility for something to go awry. One such way in which this relationship can go sideways is with hyperacusis. Hyperacusis is an auditory disorder where an affected individual perceives sound volumes much higher than they actually are.
Hyperacusis is generally recognized as a rare disorder, but it can affect people of all ages. Being aware of hyperacusis and the different treatment options can allow you to make better decisions regarding your care or a loved one who may have hyperacusis.
Below is a closer look at hyperacusis, the potential causes of hyperacusis, what effects hyperacusis can have on your life, and the potential treatments.
What Is Hyperacusis?
Hyperacusis is a complex auditory disorder characterized by pain, annoyance, fear, or general intolerance to seemingly normal sound stimuli. Those that have hyperacusis tend to have seemingly exaggerated reactions to particular sounds that are not very intense.
There are two main forms of hyperacusis that people may present. The different types seem immensely different, but in reality, they are related because they are exacerbated reactions from the body due to seemingly mundane and non-intense sounds. Additionally, both forms of hyperacusis can place similar strains on your personal and professional life.
Cochlear hyperacusis is typically thought of as standard hyperacusis. Cochlear hyperacusis is associated with exaggerated sensitivity to sounds that should otherwise be okay.
An example of some sounds that may bother an individual with hyperacusis is a running car, the sound of loose change, the clanking of dishes, someone with hard-bottomed shoes walking down a hallway. There is a near-limitless number of sounds that an individual with cochlear hyperacusis may have.
Vestibular hyperacusis is characterized by an individual having a physical reaction to certain noises. This reaction typically consists of feeling nauseous, dizzy, or generally unbalanced.
Vestibular hyperacusis seems like it could be an entirely different issue, but they both have the same general overreaction to seemingly common noises. With vestibular hyperacusis, the noises themselves are not perceived as louder, but rather the body seemingly reacts to the noise itself.
The causes of hyperacusis are not completely understood, but it is thought to originate from a general bad signaling coming from the ears and subsequent complex interactions within the brain that results in hypersensitivity.
While we are still far from understanding the true underlying pathophysiology of hyperacusis, there are known conditions that can increase your chances of heightened sensitivity to sounds.
Below is a closer look at some of the conditions that have been linked to hyperacusis.
Migraines are severe forms of headaches that can be quite painful and debilitating. When a migraine strikes, it can be difficult to find the ability to stay on task and focus due to head pain.
In addition to head pain, migraines can cause nausea, discomfort, sensitivity to light, and even sensitivity to noise like that seen in hyperacusis. The general recommendation for when a migraine strikes is to find a dark and quiet place to lay down in addition to taking OTC pain relievers.
Tinnitus is a condition that is characterized by hearing a phantom noise such as a ringing. Tinnitus is oftentimes accompanied by other hearing problems such as hearing loss and can become more noticeable when in a quiet environment. Hearing loss is one of the main contributing causes of tinnitus.
Tinnitus and hyperacusis seem to have a seeming large overlap as well. One study found that 86 percent of patients with hyperacusis also had complaints of tinnitus. While the exact mechanism for the relationship is not known, this high comorbidity points to a potential link between tinnitus and hyperacusis.
Head injuries, specifically traumatic brain injuries, are a very serious type of injury, and they can result in several difficulties with sensation, cognitive abilities and even impact the auditory centers of the brain. It isn’t uncommon for people to experience a new sensitivity to sounds and develop symptoms like hyperacusis of tinnitus following a brain injury.
Hyperacusis in head injury patients can differ from case to case depending on the sustained injury but generally, as recovery continues, the hyperacusis can diminish.
Other Potential Causes of Hyperacusis-Temporomandibular joint (TMJ) disorder
-Post-traumatic stress disorder (PTSD)
-Chronic fatigue syndrome
-Hyperacusis can also lead to phonophobia which is th fear of normal sounds.
Impact of Hyperacusis
Hyperacusis can place a significant burden on your day-to-day life. Normal sounds such as traffic, a cash register, or the clanking of dishes can be so irritating and loud to a point where it can begin to affect you negatively or even lead to pain.
From a generalized wellbeing perspective, hyperacusis has the potential to be debilitating and cause strain for your relationship, mental well-being, and overall health. There are many impacts, and below is a closer look at some specific ways that hyperacusis can impact your life.
One large debilitating aspect of hyperacusis is that it can take over your attention, affecting your ability to be productive and get your work done. Staying focused can already be hard enough, and when you add a hypersensitivity to noise, this increases the distraction factor significantly.
Many distractions can simply be ignored, but with hyperacusis, it can be difficult to just move on from it as the sound grabs your attention, and the loud perception of the sound is just too great to ignore.
Another aspect of hyperacusis is that many people elect to schedule their life around when they can get things done with the least amount of noise exposure. Going grocery shopping in the middle of traditional workdays, opting not to go to social gatherings, and slowly closing yourself off can negatively impact your social land mental wellbeing.
Another aspect that hyperacusis can affect is relationships. For those with hyperacusis, it can be difficult living with others as small everyday noises can set off pain, annoyance, and other negative feelings.
Having those you love around you can be therapeutic, but in the case of severe hyperacusis, if they are not as quiet as a mouse, they may cause undue pain by accident. Additionally, the negative emotional toll that hyperacusis can bring can make you more on edge than you would be otherwise.
Hyperacusis is a multifaceted hearing issue. Due to its complexity, there is little to do to treat hyperacusis itself, but if it is caused by something else such as a head injury or migraine, treating the underlying condition can help alleviate the symptoms of high sensitivity noise.
Hyperacusis can also occur when there doesn’t appear to be an underlying condition causing it. In this situation, there is very little that can be done to actually treat hyperacusis. Many treatments for hyperacusis revolve around reducing the reaction to sound and finding a middle ground between noise isolation and noise exposure.
Suppose you suspect you are experiencing hyperacusis, a viral infection affecting your ears, or have experienced ear damage. In that case, you can get a diagnosis and medical evaluation from your ear, nose, throat doctor (ENT), otolaryngologist, or audiologist. They will start by asking for your medical history, noting symptoms of the affected ear, and may perform a hearing test.
Depending on your diagnosis, medications, counseling, a device like hearing aids, and other medical treatments may be recommended.
Below is a closer look at some available tools to help with hyperacusis.
One common trap that those with hyperacusis fall into is that they utilize ear plugs as a means of going about their day without needing to worry about noises interfering with their day. While this may work in the short term, in the long term, it is believed that earplug use can actually worsen the sensitivity to sound.
Another recently explored option is utilizing specialized forms of earplugs known as ear filters that allow for auditory acuity and sound to come through but filter out specific harsher sounds. With short-term use, these may promise to allow those with hyperacusis to live a more normal life and not put themselves at as high of a risk of developing a worsened sensitivity.
Therapy is another effective treatment option that can help lessen the severity of hyperacusis by getting to its basis and trying to disconnect the negative associations and negative automatic behaviors to sound.
There are several different therapeutic methods, including cognitive behavioral therapy, retraining therapy, sound desensitization therapy, and much more. Sound therapy can help the patient with everyday sounds by building sound tolerance.
In summary, hyperacusis is a hearing condition that causes normal sounds to be perceived as loud, irritating, and even painful. While there are several conditions that hyperacusis is linked to, the true underlying mechanism of how hyperacusis forms are largely unknown. What is known is that treating the underlying cause can help hyperacusis, but for those without an understood underlying cause, managing symptoms is the best form of available treatment.