Hyperacusis: When Ordinary Noise is Too Loud and Painful

Hyperacusis is a condition where normal sounds or noise feel intolerably loud. For people who suffer from this condition, the sound level can be unbearable to the point of being painful and even fear-inducing.

Key takeaways:
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    Hyperacusis is a condition where people perceive sounds much louder than they really are.
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    Most people, especially children, have sound intolerance and not true hyperacusis.
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    Hyperacusis may be associated with many medical conditions or presbycusis — age-related hearing.
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    There is no known treatment for hyperacusis without a medical cause other than sound therapy or behavioral therapy.

When normal, everyday sounds grow to seemingly excruciating levels, it can be challenging to deal with, eventually affecting a person's well-being and disrupting their daily routines.

Hyperacusis: ordinary sound is painful

People with hyperacusis are unnaturally sensitive to ordinary, everyday noise. The condition stems from a problem in the way a person perceives sound. In people with hyperacusis, the perception of sound is different from reality.

People with hyperacusis are believed to interpret sound levels abnormally in the brain’s central auditory processing center. Often, people's perception of the noise level is so uncomfortable that it may cause pain.

Hyperacusis in children is particularly common under the age of three years. Many children experience problematic sounds that seem loud and uncomfortable as they learn to interact with the world. Fortunately, this loud sensitivity dissipates as the child grows older in most cases.

Adults, particularly as they age, can develop sensitivity to sounds. Ironically, this sensitivity to sounds can be associated with presbycusis or age-related hearing loss.

Age-related hearing loss is thought to be a result of a combination of cumulative environmental noise exposure, genetic predisposition, and normal factors of aging. It manifests with sounds, and especially speech, becoming muffled, garbled, or dull.

Paradoxically, adults with presbycusis can have hyperacusis to certain sounds or frequencies and tinnitus or hearing sounds that are not there, like humming or buzzing. Researchers have yet to determine a cause and are working on learning if the condition is physiological or psychological — or a combination of both.

True hyperacusis, where the person feels pain, is rare, fortunately. It affects about one in 50,000 people. It is often associated with tinnitus which affects more people. Only about one in 1000 people with tinnitus have hyperacusis.

Common symptoms with hyperacusis?

Hyperacusis can be very unsettling and isolating. Additionally, it can be associated with headaches, tinnitus, and depression.

The effects of hyperacusis tend to affect adults for far more extended periods than younger people. Children are affected more in the short term; symptoms seem to dissipate as they mature.

Scientists have yet to determine what, if any, correlation exists between hyperacusis and overall health.

The disorder's primary symptoms include being unreasonably sensitive to everyday sounds. This perception of uncomfortable loudness usually starts in one ear but often spreads, ultimately affecting both ears.

Many people, including adults and children, can develop severe feelings of isolation and difficulty tolerating even ordinary sounds and situations. This may cause withdrawal because of feelings of pain and physical discomfort with exposure to certain sounds.

Treatment may include behavioral therapy and purposeful exposure to sounds or situations in children. In adults, the solution is more elusive. Therefore, the article discusses some treatment options a little later.

Possible causes of hyperacusis

Age-related hearing loss can is the easy answer for explaining why older people have hyperacusis. However, there are other potential causes that can cause hypersensitivity to sounds, including:

  • Suffering a head injury places a person at risk of hyperacusis.
  • Having been exposed to prolonged loud noise, such as music or an explosion. However, hyperacusis and tinnitus are usually temporary after experiencing acoustic trauma.
  • Ear damage from medications like antibiotics or exposure to other toxins and radiation for the treatment of disease.
  • Lyme disease, transmitted by infected black-legged ticks, transmits the bacterium Borrelia burgdorferi, which may affect facial movement, hearing, and balance.
  • Viral illnesses that affect the inner ear and facial nerves, such as with Bell’s palsy.
  • Jaw problems, such as temporomandibular joint (TMJ) syndrome.
  • Post-traumatic stress disorder (PSTD).
  • Tay-Sachs disease (a rare, inherited disorder that affects the brain and spinal cord).
  • William’s disease (a rare disorder characterized by poor conceptual reasoning, problem-solving, motor problems, and other cognitive deficits).
  • Seizure disorders.
  • Brain aneurysm.
  • Multiple sclerosis.
  • Valium dependence.
  • Migraine headaches.
  • Psychological disorders, including depression, anxiety, and mood disorders.

Additionally, hyperacusis may present in children with brain injuries, autism, and cerebral palsy.

Diagnosing hyperacusis

A complete medical and audiology work-up should be performed in patients with hyperacusis. However, in most patients, no significant abnormality or medical condition is evident.

Researchers hypothesize that hyperacusis is associated with anxiety and fear. Therefore, they speculate that there may be a relationship between the central auditory system and the areas of the brain that elicit fear, such as the amygdala.

Treating hyperacusis

Treatment of any underlying condition is the best first step. Of course, since an underlying disease process is not always commonly established, the treatment can be more challenging. Unfortunately, there are no specific medical or surgical treatments recognized as effective.

In most cases, patients self-treat their hyperacusis with earplugs or by drowning out the offending sound with an alternative, like music or the TV. Sadly, this method can ironically worsen the hyperacusis rather than help manage the symptoms. Furthermore, despite what people with hyperacusis believe, they do not hear sounds better than others.

Sound therapy or retraining of the auditory processing center of the brain seems to be the most effective for most patients. This method includes using noise-generating devices which produce a low-intensity, barely audible white noise like static. The concept is to improve sound tolerance, which can take a year to show results, but it also may be beneficial for the treatment of tinnitus or ringing in the ears.

There is another potentially helpful remedy called recruitment. Recruitment means that sound sensitivity affects sounds according to differences in sound intensity. Another way to think of recruitment is that the person perceives sounds becoming progressively louder with increasing sound levels.

Soft sounds cannot be heard, while loud sounds become intolerable or painful. Some people with hearing loss are left with a narrow range of sound intensity that they can tolerate. An example of recruitment is seen with patients with cochlear implants when they ask people to speak up and then quickly tell them to keep their voices down.

Leading an ordinary life can be challenging for people suffering from hyperacusis. When simple ordinary household sounds, like running water or normal outdoor noise levels, are unbearable, people with hyperacusis must adapt. The medical community has yet to find a cure, but therapy and some treatment methods can help ease symptoms in some patients.

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