Hyperacusis (Reduced tolerance to sound)

Hyperacusis (Reduced tolerance to sound)


Hyperacusis is a disorder in loudness perception. Patients suffering from hyperacusis may appear overly sensitive to a range of sounds, finding many noises unbearable and painfully loud. Hyperacusis is not the same as “recruitment,” a disorder that can be a normal consequence of hearing loss and is associated with abnormal perception of sound as the volume increases.

Excessive sensitivity to sound may occur in normal-hearing individuals, either in association with ear disease, following noise trauma, in patients susceptible to migraines, or for psychological reasons. Patients with cochlear dysfunction commonly experience “recruitment,” an abnormal sensitivity to loud sounds despite a reduced sensitivity to softer ones.

Fitting hearing aids and other amplification devices to patients with recruitment requires use of compression circuitry to avoid uncomfortable overamplification. For normal-hearing individuals with hyperacusis, use of an earplug in noisy environments may be beneficial, though attempts should be made at habituation.

Types of Hyperacusis

There are two types of hyperacusis: cochlear and vestibular. Cochlear, the most common form, causes pain in the ear, frustration, and a general feeling of intolerance to everyday sounds. Vestibular hyperacusis, on the other hand, causes feelings of nausea, dizziness, and imbalance when particular sounds are present. Both types of hyperacusis can cause anxiety, stress, depression, social isolation, and phonophobia (fear of normal sounds).


Causes of Hyperacusis

Hyperacusis affects people of all ages, and it can influence your hearing in one or both ears. Typically, people are not born with this rare condition. It can develop over a period of time or emerge quite suddenly. Causes of hyperacusis include, but are not limited to, the following:

  • Exposure to loud noise (causing damage to the cochlea)
  • Head injury
  • Lyme disease
  • Bell’s palsy
  • Tay-Sachs disease
  • Williams syndrome
  • Posttraumatic stress disorder (PTSD)
  • Systemic lupus erythematosus (SLE)
  • Viral infections that affect the inner ear or facial nerve
  • Ear damage due to toxins or medication
  • Temporomandibular joint (TMJ) disorder
  • Airbag deployment
  • Migraines
  • Ménière’s disease
  • Multiple Sclerosis
  • Sometimes children with autism or cerebral palsy also suffer from hyperacusis, and it can occur in children with brain injuries.

Although experts do not know exactly why hyperacusis occurs, theories include a malfunction of the ear’s protective hearing mechanisms, damage to a portion of the auditory nerve, a problem with the central processing system, or a malfunction of the auditory nerve.

Hyperacusis Signs and Symptoms

The hallmark symptom of hyperacusis is having a reduced tolerance and increased sensitivity to everyday sounds in your normal environment. People who suffer from the disease often complain of living in a world in which the volume seems to be turned up too high. Because of this, their quality of life is affected, and they may begin to wear earplugs or earmuffs in public situations where they cannot control the noise.

For people with hyperacusis, the everyday, normal sounds that most people hardly notice suddenly become irritating and painful. Often the most disturbing sounds are sudden, high-pitched noises, such as alarms, bus brakes, the clanging of silverware and dishes, children’s screams and clapping.

Because people with the condition are so sensitive to noise, they may develop a fear of noise, known as phonophobia. As a result, this may cause them to avoid social and public situations in fear of exposing their ears to harmful sounds.

Treatment for hyperacusis

There is usually no cure once noise sensitivity has started, because the common causes are noise damage and ageing damage to the inner ear. Avoiding exposure to noise will help.

Other disorders of the inner ear, which may be mistaken for hyperacusis, are treatable, so prompt assessment of the ears is important.

Generally, sound sensitivity is managed in a number of ways, including:

  • wearing hearing protection in noisy environments, such as when working with power tools or being around loud music. This is because tinnitus and sensitivity may be exacerbated by excessive sounds. It is not necessary to wear hearing protection for everyday activities
  • reintroducing everyday sounds as soon as possible: this is known as desensitisation
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  • asking people to avoid raising their voice when they speak to you. Let them know it irritates your ears and distorts the message
  • talking to someone about your symptoms if anxiety or other reactions persist. A counsellor or psychologist may be able to talk with you and help you to identify factors that may be influencing your reactions to loud sounds, and help you develop coping strategies. Knowing and remembering that hyperacusis is not caused by a threatening disorder can help your tolerance significantly
  • tinnitus retraining therapy (TRT): this involves wearing special hearing aids called ‘noise generators’, which can, over time, reduce your sensitivity to noise. The ears become accustomed to the barely audible ‘white noise’ and eventually ignore it
  • medication to help you sleep: this may be needed in the short term.

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