Hyperacusis - A Guide

This article is for individuals who experience heightened sensitivity to sound and want to understand hyperacusis better.

Whether you're seeking information for yourself or a loved one, this guide will provide insights into the condition, its causes, symptoms, and available treatments.

If you're experiencing issues in relation to hearing loss and are local to Suffolk, consider reaching out to Ear View for professional assistance.

What is Hyperacusis?

Hyperacusis is a condition characterised by an increased sensitivity to sound; sufferers will experience everyday noises as much louder than they are, often leading to discomfort or pain.

The term “Hyperacusis” was introduced in 1938 by H. B. Pearlman 1938 while studying facial paralysis. However, over the following years, there was much debate over the terminology, with some arguing the term was too broad.

In 1949, a researcher named Tschiassny argued that terms such as phonophobia (at the time meaning increased sensitivity to auditory stimuli, now meaning fear or aversion to sound) would be more appropriate. Tschiassny was researching pain-related auditory stimuli in patients with Bell's palsy and argued that the term hyperacusis was insufficient as it did not relate to increased hearing acuity.

In 2010, another researcher, Tyler, reviewed many definitions of Hyperacusis and noted that many included pain as a symptom, with others focussing on loudness intolerance. As a result, Tyler categorised Hyperacusis into four subtypes: loudness, pain, annoyance, and fear.

Loudness Hyperacusis

Loudness Hyperacusis occurs when individuals perceive everyday environmental sounds as uncomfortably loud, even at normal volumes. Sounds such as running water, everyday conversations, traffic, hoovers, etc., seem intolerably loud.

Pain Hyperacusis (Noxacusis)

Pain Hyperacusis occurs when exposure to certain sounds causes physical pain in the ears or head. Loud conversations or quiet sounds, such as rustling paper, can trigger burning, stabbing, or deep-aching sensations in the sufferer.

Annoyance Hyperacusis

Annoyance Hyperacusis is when certain sounds provoke an extreme emotional response or irritation beyond what would be classed as typical discomfort. An individual with annoying Hyperacusis may become very aggravated by everyday sounds.

Fear Hyperacusis 

With Fear Hyperacusis, individuals' responses to sound are psychological rather than sensory. Some may develop an intense fear of particular noises. Over time, this condition can lead to avoidance behaviors, with the brain expecting to experience pain or distress from the sound.

What causes Hyperacusis, and when does it develop?

Hyperacusis has no single cause; however, research indicates that several factors contribute to its development.

These factors are noise-induced damage, neurological disorders, ear trauma, side effects of certain medications, or stress and anxiety. Additionally, it can also develop suddenly, gradually, during childhood, or as we age, depending on underlying conditions or a triggering event.

Prolonged Sound Exposure

Prolonged exposure to loud sounds (for example, in the workplace or loud music events) can trigger loudness hyperacusis. In the ear, there are tiny hair cells; these cells convert sound waves into electrical signals that are transmitted to the brain via the auditory nerve. Exposure to loud noises can damage or destroy these cells and disrupt the brain's ability to regulate loudness perception, leading to a permanent sensitivity to sound. The onset of Hyperacusis from loud noise exposure tends to be gradual. However, it can be triggered suddenly by one event involving a deafening noise.

Neurological Disorders

Neurological disorders and sensory processing disorders are commonly associated with annoyance hyperacusis. Neurological disorders, such as autism, ADHD, migraines, and PTSD, can lead to heightened sensory sensitivity. The brain incorrectly regulates which sounds should be ignored and amplifies background noises. People with these conditions, and others such as anxiety or stress, can become hyper aware of certain sounds and associate them with discomfort, over time this can condition the brain to react negatively to them. Annoyance hyperacusis stemming from a neurological condition or a triggering event can occur gradually or suddenly.

Physical Trauma & Injury

Ear Trauma and head injuries have also been linked to both loudness hyperacusis and pain hyperacusis. If the cochlea is injured, hair cells in the cochlea are damaged, or the eardrum is ruptured during an incident, it can result in loudness hyperacusis. Additionally, if the auditory nerve is damaged, the brain is injured or concussed, or balance-related structures in the ear are damaged it can alter how the brain interprets sound or worsen sound intolerance. When the ear or brain is injured, the brain attempts to compensate for the hearing loss by increasing sensitivity to sound; nerve pathways involved in sound regulation become overactive and can amplify sound to uncomfortable levels. When the ears ability to filter loud noises is disrupted it can lead to pain responses.

Medications

Certain medications can lead to Hyperacusis, either as a temporary side effect whilst taking the medication or as a long-term condition due to damage to the auditory system. It can come on suddenly or gradually depending on the drug's effects and the individual's sensitivity to it. Medications that damage the auditory system are known as ototoxic; their side effects range from damaging tiny hair cells within the cochlea and causing temporary hearing fluctuations to worsening sound intolerance by altering neurotransmitter activity. Ototoxic medication-induced Hyperacusis is more commonly associated with loudness hyperacusis but has been linked to pain hyperacusis when drugs are used that alter nerve function.

Mental Trauma & Injury

Fear hyperacusis can develop due to various factors ranging from traumatic sound experiences, PTSD, and chronic anxiety disorders to negative sound associations. For example, individuals in accidents, combat situations, or natural disasters may become hypersensitive to loud or unpredictable noises. Fear hyperacusis can result from the body’s ‘fight or flight’ response, interpreting even moderate sounds as threatening or dangerous. Studies show that people with chronic anxiety disorder are at more risk of developing fear hyperacusis, stress, and anxiety, which can heighten senses, making sounds seem alarming or intrusive. Fear hyperacusis can develop gradually (mild discomfort worsened over time after repeated exposure to triggering sounds) or suddenly (triggered by a single traumatic event). Sound sensitivity in these cases tends to worsen due to avoidant behaviors. As individuals may start to avoid the noise due to fear, their tolerance to it becomes weaker and weaker, making environments more overwhelming. 

What are the signs and symptoms of Hyperacusis?

The signs and symptoms of Hyperacusis affect individuals differently depending on the specific subtype they experience. The condition can range from just a mild sound intolerance to severe pain or emotional distress. Below are some of the primary symptoms associated with each subtype.

Loudness Hyperacusis

●      Overwhelming sensitivity to everyday sounds like household appliances, traffic, telephones ringing, and talking at a conversational level.

●      Avoidance of loud environments due to discomfort or stress.

●      Experiencing sound at a distorted or magnified level.

●      Fatigue, stress, or upset from excessive exposure to everyday sounds.

Pain Hyperacusis

●      When exposed to certain sounds, burning, stabbing, and/or aching sensations in the ear or head. Sometimes, the pain can linger even after the sound has stopped.

●      Extreme discomfort or pain when hearing high-pitched sounds.

●      Avoidance behaviors, such as wearing ear protection or earplugs to reduce exposure to certain sounds.

Annoyance Hyperacusis

●      When certain sounds (for example, chewing, tapping, humming) become unbearable, causing the individual intense frustration and distress.

●      Increased irritability when exposed to triggering sounds

●      Emotional reactions to sounds such as aggression, stress, or frustration.

Fear Hyperacusis

●      Anxiety or panic when anticipating a noise the individual finds triggering

●      Feeling on edge or anxious in environments where the triggering noise could occur.

●      Individuals adopt avoidance behaviors to avoid or protect themselves from a triggering noise, such as staying in quiet places, leaving events early, or wearing ear protection in environments that are not usually required.

What other conditions are often associated with Hyperacusis?

Hyperacusis often co-exists with other conditions, such as Tinnitus, Misophonia, Anxiety, and Autism.

Tinnitus is a condition that causes ringing or buzzing in the ears without an external source and often is the result of auditory dysfunction. Studies have shown that individuals suffering from Hyperacusis are up to 3.5 times more likely to develop tinnitus.

Misophonia, unlike Hyperacusis, which amplifies sounds, is an intense psychological reaction to specific sounds, like chewing, tapping, or nails on a chalkboard. It can trigger extreme feelings of irritation, anger, and anxiety and lead to avoidance behaviors.

Many individuals with Autism will experience sound sensitivity, including Hyperacusis and misophonia. Their brains process sensory input differently, which can lead to heightened responses to certain noises - this sensitivity can lead to sensory overload and distress when in loud environments. Some research suggests that up to 86.6% of Autistic children exhibit a form of auditory disorder.

Anxiety and Hyperacusis are closely linked, with individuals with anxiety disorders more likely to find certain noises overwhelming and trigger a stress response. Conversely, conditions like Hyperacusis, misophonia, and tinnitus can heighten anxiety and start a cycle of distress. According to studies, over 50% of people who suffer from a psychiatric disorder also have Hyperacusis.

Is having Hyperacusis a wider health risk?

 Hyperacusis in itself is not a life-threatening condition. However, it can impact daily life and lead to mental health challenges.

Avoidance behaviors related to Hyperacusis, like avoiding noisy environments, can lead to social withdrawal. Also, as previously mentioned, Hyperacusis has been linked to anxiety disorders, either exacerbating conditions or occurring as a result.

Hyperacusis has also been linked to other medical conditions, so if you have started experiencing symptoms with no known underlying causes, it is important to consult with your doctor.

How is Hyperacusis diagnosed?

Hyperacusis is diagnosed through a test called a ‘Loudness Discomfort Test’ (LDL). An audiologist performs this test to assess an individual’s tolerance to loud sounds. The process comprises three parts: pure tone audiometry, gradual volume increases, and recording thresholds.

During pure tone audiometry, the patient listens to sounds at different frequencies and volumes. The audiologist slowly raises the sound level until the patient indicates they are experiencing some discomfort. The audiologist then records at which point the sound has become uncomfortable at each frequency.

Is Hyperacusis curable? 

Hyperacusis is not entirely curable, but symptoms can be effectively managed with the correct treatment of the underlying cause. If Hyperacusis is linked to another condition, treating the condition may help reduce sound sensitivity.

What treatments and/or cures can help with Hyperacusis?

 Treatment for Hyperacusis will depend on the underlying cause, but many treatments are available to help reduce sound sensitivity and improve daily life.

These include:

●      Sound therapy - This  involves gradual exposure to low-level sounds. It helps to desensitise the ears and improve the individual’s tolerance to everyday noises.

●      Cognitive Behavioural Therapy (CBT) - Cognitive behavioral therapy is a psychological approach that helps individuals manage the emotional and behavioral impact of Hyperacusis. Its main focus is to change negative thought patterns, reduce anxiety, and help patients through cognitive restructuring, relaxation techniques, and behavioral adjustments.

●      Tinnitus Retraining Therapy (TRT) - TRT helps sufferers of tinnitus habituate to tinnitus and Hyperacusis by reducing their emotional and physiological response to sound. The therapy is based on the idea that the brain can learn to ignore tinnitus and reduce sensitivity over time through counseling, gradual exposure, and sound therapy.

●      Hearing aids and Sound Generators - Both devices work by introducing sound at a comfortable level and, over time, slowly increasing exposure to assist the brain in regulating general environmental noise. Hearing aids, although mainly used for hearing loss, can also incorporate sound therapy features. Similarly, sound generators these devices produce low-level white noise to desensitize the auditory system and improve tolerance to everyday sounds. 

●      Lifestyle adjustments - Lifestyle adjustments can help individuals manage their sensitivity to sound and decrease its impact on their daily lives. Adjustments such as healthy sleep habits (poor sleep can exacerbate Hyperacusis), stress management, avoiding complete silence, and relaxation techniques such as yoga and meditation (lowering stress levels) have been shown to benefit those with Hyperacusis.

Hyperacusis can be challenging, but with the right information and support, individuals can manage their symptoms effectively. If you're experiencing any other ear-related issues, consider booking an appointment at Ear View for expert guidance.