Hyperacusis: Overview, symptoms, Causes, Diagnosis and management

Hyperacusis is a medical term used for a rare hearing disorder in which people perceives normal sounds as abnormally loud or painful. These people show inappropriate responses to the sounds that are neither threatening nor uncomfortably loud to a typical person. Some also called it as hypersensitivity to sounds. The people are not born with it. It is an acquired condition and many people having hyperacusis have normal hearing. These people may find sound of car engine or even rustling paper uncomfortable. The disorder varies in the term of severity such that in some people it is just a mild inconvenience while for some it is a life changing condition. Quality of life of an individual with hyperacusis can be greatly compromised,

According to the hyperacusis network, every 1 person out of 50,000 people has hyperacusis. It has been seen that 1 out of every 1000 people suffering from tinnitus that is buzzing or ringing sensation in ear also have hyperacusis.

Signs and symptoms

The symptoms depend upon the severity of the disorder but the main symptoms of feeling discomfort when hearing sounds is common to all. It can develop is one or both of the ears. As the severity increases, person feel the sound as painful as starts avoiding the situations which produce sounds leading to a sense of phonophobia that is fear of sound. People tend to stay alone and avoid conversations. This condition is also linked to anxiety and depression. Sometimes it may happen that all the sounds being perceived are uncomfortable. Symptoms can be summarized as

• Discomfort to everyday routine sounds which often begins in one ear and then progresses to the both.
• Facing difficulty in tolerating ordinary situations and environments
• Isolation to avoid sounds
• Symptoms of anxiety or physical discomfort.

Causes

Since it is an acquired condition that means it is acquired during the lifetime of person and not present from birth. The causes can differ from person to person like

Loud noise exposure: it is one of the major causes. It may be triggered by a single sudden intense sound such as that of a gunshot. It may also develop due to prolonged exposure to the loud noise without hearing protection.

• Trauma or injury to head in situation like air bag deployment
• Surgery to jaw or face
• Viral infection of the ear
• Bell’s palsy: there is a damage to the nerve which control the movements of the facial muscles
• Lyme disease

Studies have shown that there are varieties of neurological conditions which can be associated with hyperacusis like

• Chronic Fatigue syndrome
• Post-traumatic stress disorder
• Tay – Sach’s disease
• Some form of epilepsy
• Migraine headaches
• Depression
• Autism: studies have reported that about 40% of children with autism have hyperacusis

On the other hand, some individual may not have any apparent cause.

Diagnosis

If you suspect yourself facing difficulty with normal sound, you should seek the help of a doctor. The doctor who specializes in the problems related to ear are known as ENT specialists or otolaryngologists. The doctor will ask you questions about your medical history, perform ear check-up, a hearing test and audiologic evaluation to confirm the diagnosis. Your doctor will use your medical history to suspect and find out the cause of hyperacusis to purpose a treatment.

Management

There is no specific surgical or medical treatment for hyperacusis. The management will depend upon the underlying cause so finding the cause is important. In some cases, it gets better on its own and no treatment is required especially in the cases related to the trauma to the brain. Patients are counselled about their conditions. There are some purposed management modalities like

Counselling: patients along with their family members are counselled about their conditions. People with hyperacusis have a tendency to use earplugs or earmuffs to reduce the intensity of the sound to avoid distress but in the long run it would worsen the condition as it will further increase the sensitivity of your ear to the sounds. So proper counseling of the patients is needed.

Sound desensitization: In this therapy, you will listen to sounds for a specific period every day. You will slowly and gradually be escalated to louder sounds such that your ears get used to the sound in the comfortable manner. This involves a noise-generating device which is worn on the affected ear which produces a gentle static like sound that is barely audible. It usually takes the duration of 6 months to a year to get the most of the benefit of this therapy.

Cognitive behavioral therapy: it is necessary in those patients who are suffering from the psychological distress associated with the hyperacusis. The doctor may also give you medicine to cope with the stress condition but there is no medication as such for hyperacusis.

References

1. Baguley DM. Hyperacusis. Journal of the Royal Society of Medicine [Internet]. 2003 Dec;96(12):582. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539655/

2. Hyperacusis—An increased sensitivity to everyday sounds | Otorhinolaryngology – Head & Neck Surgery | McGovern Medical School [Internet]. Available from: https://med.uth.edu/orl/2010/10/12/hyperacusis-an-increased-sensitivity-everyday-sounds/

3. Hyperacusis and otitis media in individuals with Williams syndrome. Klein AJ, Armstrong BL, Greer MK, Brown FR 3^rd J Speech Hear Disord. 1990 May; 55(2):339-44

4. Katzenell U, Segal S. Hyperacusis: review and clinical guidelines. Otol Neurotol. 2001 May;22(3):321–6; discussion 326-327.