Normal everyday sounds seem overly magnified, as if someone has turned up the volume of the ear and the dial is stuck at a high volume. Sounds such as turning newspaper pages, removing dishes from the dishwasher, brushing one’s hair or running water in the sink become intolerable to those with hyperacusis.
Individuals suffering from hyperacusis will report many sounds in their environment (while hardly noticed by their peers) are uncomfortably loud and sometimes painful. Generally, soft sounds won’t be bothersome, but moderate and loud sounds can become so bothersome that they interfere with daily activities and wreak havoc on personal and work relationships. The changes that occur within the central auditory nervous system can also lead to engagement of the limbic (emotional system) and the sympathetic nervous system (fight-flight), which in turn will lead an individual to want to wear hearing protection earplugs or headphones all day long. This causes the individual to “overprotect” their ears, which then creates a vicious cycle, further exacerbating the sound sensitivity problem.
Although there are many associations, a direct underlying cause for hyperacusis is rarely found. The literature points to noise exposure as the most common cause of hyperacusis, followed by hearing loss. However, the relationship between hyperacusis and hearing loss is complicated and not well-understood. Hyperacusis can occur gradually or suddenly and can be devastating to an individual’s job, relationships and quality of life. For some, it’s a minor nuisance, but others, it’s a life altering condition.
It is critically important for any individual experiencing sound tolerance problems to have a comprehensive audiologic evaluation (hearing test) with an audiologist, preferably one that has knowledge and experience with hyperacusis. After the audiologic evaluation, Dr. Novick will recommend a consultation with an otolaryngologist, a physician specializing in ear disorders for proper differential diagnosis of conditions that could be contributor to hyperacusis.
In addition, if a patient is suffering from significant distress, Dr. Novick will also recommend working with a psychologist or mental health wellness specialist to help implement coping strategies such as cognitive behavioral therapy and mindfulness. In some cases, patients may need to work with a psychiatrist for medication management support of any associated anxiety and depression. In our office, Dr. Novick will use directive educational counseling principles from TRT, otherwise known as Tinnitus Retraining Therapy.
Unlike tinnitus, hyperacusis is a treatable condition which can be improved in many patients with varying degrees of success, using a structured combined protocol of sound therapy and guided mental health wellness therapy. For sound therapy, an audiologist will fit the patient with ear-level broadband sound generators, that emits white and/or pink noise, with controlled volume steps. There are hearing aids, with the microphones turned off and which can be Bluetooth enabled, then allow a patient to stream a variety of steady-state soothing, pleasant sounds of their choice from their smartphone. It is important for the patient to remember that recovery from hyperacusis requires time and patience, as it will take time to desensitize the brain and recalibrate the central auditory nervous system back to a more normalized sound sensitivity.
Keep in mind that recovery may be complete or only partial. During treatment, Dr. Novick will often re-measure your loudness discomfort levels (LDLs) to monitor your progress. Individuals without hyperacusis will have LDLs in the 85-90+ dB (decibel) range. Patients with hyperacusis would have LDLs well below that level (75 dB or lower). In addition, patients will benefit significantly from working with a psychologist, psychiatrist, and/or licensed mental health specialist for additional support in management of associated anxiety and depression.
Treatment requires frequent directive educational counseling and regular follow-up visits. It is recommended that patients to fully commit to a treatment plan tailored specifically for them in order to maximize their chances for a successful outcome. With a combined structured treatment protocol using both sound therapy and mental health wellness management, 50-80% of hyperacusis patients have reported improvement and reduced sound sensitivity over time (Fackrell, et. al., Biomed Res Int., 2017).
Hearing Protection for those with hyperacusis
Some individuals dealing with hyperacusis try to avoid intolerable loud sounds by wearing ear plugs or hearing protection devices. While this may sound like a good idea, this can actually be counterproductive and may make you more sensitive to the sounds around you. This is otherwise known as “overprotection”. Ear protection should not be used for normal day to day living activities. It is sensible to wear hearing protection when you will be exposed to unsafe loud sounds (e.g. lawn mowers, DIY power tools, dance clubs, rock concert venues, sporting arenas). Dr. Novick will review the proper use of hearing protection with you at your appointment.
Patients looking for more information on hyperacusis, a trusted resource is Hyperacusis Research found at https://hyperacusisresearch.org/.
Fackrell, K., Potgieter, I., Shekhawat, G., Baguley, D., Sereda, M., and Hoare, D. Clinical Interventions for Hyperacusis in Adults: A Scoping Review to Assess the Current Position and Determine Priorities for Research; Biomed Research International: 2017; 2017: 2723715. doi: 10.1155/2017/2723715.
Goodson, S. and R. Hull, American Speech-Language-Hearing Association (ASHA) Audiology Information Series: Hyperacusis, 2015: https://www.asha.org/siteassets/ais/ais-hyperacusis.pdf