What is Hyperacusis?

Hyperacusis is reduced tolerance to normal environmental sounds. This reduced tolerance may come on gradually or occur suddenly. Everyday noises may vary from being slightly irritating to being unbearable or even painful. Hyperacusis is often (but not always) accompanied by some degree of hearing loss and/or tinnitus (ringing in the ears).

Severe hyperacusis can impact negatively on one’s quality of life, leading to social isolation and depression.

What causes Hyperacusis?

The answer to this is not simple, as hyperacusis is not yet fully understood. In the majority of cases, no underlying medical condition is found. It is, however, also associated with other conditions, such as:

• Hearing loss
• Noise exposure
• Tinnitus (ringing/hissing)
• Acoustic trauma
• Ototoxic (ear damaging) medications
• Lyme disease
• Ménière’s disease
• Temporomandibular joint (TMJ) disorder
• Head injury
• Surgery
• Superior canal dihiscence syndrome (SCDS)
• Autism
• Williams syndrome
• Post-traumatic stress disorder and depression
• Bell’s palsy and Ramsay-Hunt syndrome
• Migraine
• Stapedectomy
• Perilymph fistula

One explanation regarding the cause of hyperacusis is that the ear’s natural protective mechanisms (that usually work to minimise the harmful effects of loud noise) are malfunctioning or hyperactive. The hearing nerve, the facial nerve and the processing centre of the brain have all been thought to be possible causes.

Tinnitus and hyperacusis are often seen as two sides of the same coin, as the treatment and suspected causes of the two conditions overlap in many ways.

What can be done to treat Hyperacusis?

All patients with decreased sound tolerance can be helped. There are various treatment methods available:

Sound generators have shown promise amongst those with hyperacusis. The theory is that the ear is able to normalise its tolerance by listening to broadband sounds (e.g. the sound of the ocean) at a barely audible level, for a set period of time each day. Hearing aids may be programmed to act as sound generators, and there are also several smartphone apps available for this purpose.

Direct counselling from an experienced hearing professional or a psychologist familiar with cognitive-behavioural therapy (CBT) may be effective.

Desensitisation therapy involves identifying and recording bothersome sounds. The patient is given control over the volume, which is then increased gradually over time, as tolerance improves.

Sound Enrichment with comfortable, pleasant sounds such as the waves of the ocean or the wind in the trees, is an important part of hyperacusis treatment. Those suffering from hyperacusis often wish to avoid noise, as they feel that noise is a preventable cause of sensitivity. HOWEVER, reducing one’s exposure to environmental sounds, especially by using ear plugs, further decreases one’s tolerance for sound. It is critical to keep one’s ears stimulated and active in order to rebuild one’s tolerance.

Hyperacusis in Children

Hyperacusis in children may present on its own, or in association with other conditions such as:

• Attention deficit disorder (ADD)
• Sensory processing disorder (SPD)
• Autism
• Williams syndrome

Children with hyperacusis often feel isolated and misunderstood. It is therefore important to develop strategies to help them to cope with noise.

Children often respond quickly to desensitisation therapy techniques (mentioned on the previous page), due to their still-developing brains.

It is important to speak rationally with children about the sounds that bother them, in order to deal with any emotional links that may exist. For example, the sound of an ambulance’s siren may induce fear because the child is aware of what ambulances are used for.