Have you ever been bothered by sounds that are perceived at a normal level by others? For some people, soft sounds may be uncomfortable including water running in the sink or even people chatting at a conversational level. Hyperacusis is a condition in which individuals experience heightened sensitivity or discomfort in response to everyday sounds. This sets it apart from other sound-related issues such as misophonia and phonophobia (1). In this post, we will delve into loudness hyperacusis while describing other forms as well. The post will look at the symptoms, causes, treatments, and recommendations for those experiencing potential sound intolerances.
Pain hyperacusis is characterized by intense, sharp head pain or migraines and is less common than loudness hyperacusis. It’s crucial to differentiate hyperacusis from other conditions like the Tulio phenomenon, which induces sound-related dizziness, and loudness recruitment, typically observed in individuals with hearing loss, where only loud sounds cause discomfort (1).
Approximately 2-3% of the population experiences hyperacusis, with tinnitus accompanying it in 80% of cases (2). Furthermore, about half of those with hyperacusis also have some degree of hearing loss. Common symptoms encompass sleep disturbances, negative emotional well-being, social isolation, anxiety, depression, aural fullness, ear pain, tinnitus, concentration difficulties, and/or discomfort when exposed to perceived loud sounds (3).
Although the precise causes of hyperacusis remain under research, it is often associated with multiple contributing factors. Prolonged or sudden exposure to loud noise is a significant factor, even in individuals without hearing loss. In cases of hearing loss, research suggests the etiology may be damage to the auditory nerve (4). Furthermore, another theory suggests that patients with hearing loss may also suffer from increased gain within the central auditory pathways. In sensorineural hearing loss, there is reduced input from the inner ear through the auditory nerve and into the central auditory system. Research indicates that auditory plasticity is known to describe one of the sensations of hyperacusis in patients with cochlear hearing loss. Even with a decrease in output to the cochlea (inner ear) the central auditory system may further increase its gain response and upregulate the response to sound leading to overstimulation of sound stimuli perceived at the level of the auditory cortex (4).
Effective treatment for hyperacusis typically involves a combination of approaches aimed at reducing symptoms and developing coping strategies. Sound therapy, utilizing wideband noise generators, gradually increases exposure to acoustic stimulation, retraining neural connections to tolerate louder sounds that are comfortable (4). Cognitive Behavioral Therapy (CBT) has proven highly effective, with 85% of patients reporting its success in reducing hyperacusis handicap scores (5). Lastly, tinnitus retraining therapy (TRT) is another valuable option, particularly for individuals with both tinnitus and hyperacusis, helping patients regain control over their reactions to these conditions (6).
If you suspect you have hyperacusis, seeking a hearing assessment by a qualified professional is advisable. Audiologists employ various methods, including loudness discomfort level tests, to diagnose hyperacusis. To prevent hyperacusis, it’s crucial to wear hearing protection in noisy environments or during prolonged exposure to loud noise, safeguarding your hearing health.
References
- Baguley DM. Hyperacusis. J R Soc Med. 2003;96(12):582-585. doi:10.1177/014107680309601203
- What is hyperacusis? – balanceanddizziness.org. Accessed October 8, 2023.
- Paulin J, Nordin M, Nyback MH, Nordin S. Associations between hyperacusis and psychosocial work factors in the general population. Int Arch Occup Environ Health. (2018) 92:59–65. doi: 10.1007/s00420-018-1356-x
- Aazh H, McFerran D, Salvi R, Prasher D, Jastreboff M, Jastreboff P. Insights from the First International Conference on Hyperacusis: causes, evaluation, diagnosis and treatment. Noise Health. 2014;16(69):123-126. doi:10.4103/1463-1741.132100
- Aazh H, Knipper M, Danesh AA, et al. Insights from the third international conference on hyperacusis: causes, evaluation, diagnosis, and treatment. Noise Health. 2018;20(95):162-170. doi:10.4103/nah.NAH_2_18
- Jastreboff PJ, Jastreboff MM. Tinnitus Retraining Therapy (TRT) as a Method for Treatment of Tinnitus and Hyperacusis Patients. Journal of the American Academy of Audiology. 2000;11(3):162-177. doi:10.1055/s-0042-1748042
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