What Is Hyperacusis

Hyperacusis is an exaggerated response to normal sounds.¹ It can be referred to as sound sensitivity, whereby everyday sounds seem much louder to you than they should. Hyperacusis can cause severe impairment, and currently, there is no known cure.^2,5 

Hyperacusis is an auditory condition characterized by challenges in tolerating sounds that would typically not be bothersome to the majority of individuals.^1,7 It varies in severity from mild to severe in different people and at different episodes. Hyperacusis involves a broad spectrum of responses to sound, categorized as excessive loudness, annoyance, fear, and pain.²

When you have hyperacusis, you may be affected by sounds like house appliances, for example, a washing machine or vacuum cleaner, jingling coins, a barking dog, a car engine, or someone chewing.⁵ Hyperacusis can affect 1 or both of your ears. It can come on suddenly after a loud noise like fireworks or develop over time.⁵ 

Overview

Hyperacusis has been defined as ‘unusual tolerance to ordinary environmental sounds that are neither threatening nor uncomfortably loud to a typical person’.¹ The causes of hyperacusis are not well known. However, this condition has been associated with different conditions, such as head injury, viral infections, or neurological disorders. In some people with Hyperacusis, sounds are perceived as being much louder than they would be by someone without this disorder. Some people may have emotional reactions to sounds, such as being annoyed or afraid.⁷

People suffering from hyperacusis perceive normal sounds as more annoying or disturbing than normal, resulting in symptoms such as headache, fatigue, and concentration difficulties.³ Reactions are characteristically triggered by sounds in general, even at low intensities, rather than specific sounds, as in misophonia and phonophobia.³ The latter are other types of hearing sensitivity and are defined below as:

• some sounds make you angry (misophonia)
• some sounds make you anxious (phonophobia)
• your ears having trouble adjusting between quiet and loud sounds (recruitment)

Misophonia and phonophobia can occasionally appear together with hyperacusis, although the illnesses are not mutually inclusive.³ Hyperacusis is considered a rare condition. According to the CDC, a 2014 survey found that 5.9% of Americans are sensitive to everyday sounds.⁹ Prevalence rates of 8.6 and 15.2% have been reported from a Swedish and Polish study, respectively.³

Symptoms of hyperacusis

Hyperacusis Symptoms can vary in intensity, affecting one or both ears. Common symptoms include ear pain or discomfort, headaches and a sensation of thumping or fluttering. Individuals dealing with hyperacusis often find themselves facing challenges in their daily activities and may adapt by avoiding social gatherings or situations that could trigger their symptoms. 

Tinnitus, which is the sensation of hearing a sound when there is no external source for that sound, is particularly common in hyperacusis.⁶ People suffering from hyperacusis also have other conditions such as fibromyalgia, chronic fatigue syndrome (CFS), as well as other environmental intolerances such as multiple chemical sensitivity, nonspecific building-related symptoms, and symptoms attributed to electromagnetic fields.³

Other common comorbid illnesses in hyperacusis are Bell's pares, facial paralysis, Williams syndrome, autism, depression or anxiety, ménière's disease, misophonia, noise-induced hearing loss, obsessive-compulsive disorder (OCD), otosclerosis, phonophobia; and posttraumatic stress disorder (PTSD).^8,3

Regarding psychiatric disorders, 56% of patients referred to an ear, nose, and throat clinic with hyperacusis as primary diagnoses were found to meet the criteria for at least one psychiatric disorder. More specifically, 47% met the criteria for anxiety disorder, 8% for major depression, and 3% for posttraumatic stress disorder (PTSD).³

Causes of hyperacusis

Causes of hyperacusis are unclear. However, hyperacusis is known to appear on its own after hearing a sudden loud noise, such as fireworks. It is also known to appear alongside other conditions such as tinnitus, head injury, Bell’s palsy, Lyme disease, migraines, Williams syndrome and autism.⁵

According to Audiology Center Northwest, hyperacusis frequently arises from a phenomenon known as auditory gain. This occurs when the brain amplifies regular sounds to compensate for the damage.⁹ Contributing factors to auditory gain include noise pollution, oftentimes related to occupation, head injury, ototoxic medications and viral infection that affects the inner nerve, such as Bell’s palsy.⁹

Hyperacusis risk factors

Hyperacusis has also been found to be more common among men (61%), whereas documentation appears to be lacking regarding marital status and education as well as lifestyle factors (e.g., smoking habits and physical exercise) and perceived general health.³ However, advanced age has been shown to be associated with hyperacusis.

Hyperacusis diagnosis

In the United Kingdom, audiologists diagnose hyperacusis through an assessment which usually involves pure-tone audiometry, the measurement of uncomfortable loudness levels (ULLs), and self-report questionnaires, typically the hyperacusis questionnaire (HQ).⁴

Treatment and home remedies

Treatment for hyperacusis may include one or more of the following intervention options:

Informational and educational counselling

Patients presenting hyperacusis symptoms require education and counselling. It is, however, important to include the patient's support system (e.g., family, significant others) when counseling for hyperacusis management.⁸ Professional referrals may also be considered to address the psychosocial aspects of hyperacusis.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a specific type of therapy that focuses on modifying problem emotions, thoughts, and behaviours.⁸ For the psychological distress, depression, anxiety, and insomnia associated with hyperacusis, cognitive–behavioural therapy (CBT) has been identified as the treatment of choice.

Sound therapy

Sound therapy involves introducing sound into your environment in order to dilute the sounds that you are finding unpleasant.⁷ Sound therapy for hyperacusis involves patients listening to low-level sounds for extended durations to promote habituation.⁸ Binaural sound therapy, utilizing wide-band generators positioned at ear level, is administered even in cases where symptoms affect only one ear. 

Treatment focuses on desensitization, with the sound intensity gradually increasing from a low level over time.¹ Sound therapy might also involve wearing earpieces called White Noise Generator (WNG) that make white noise.^1,5 Some people find that auditory desensitisation gives them initial relief, but it typically takes 12–18 months for most people to find a long-term improvement without the need to use noise generators. 

Sound therapy options for hyperacusis are as follows:

• Continuous low-level broadband noise
• Music or environmental sounds
• Successive approximations to high-level broadband noise
• Successive approximations to troublesome sounds
• Gradual increase of maximum output of hearing aid or ear-level sound generator 

Hyperacusis activities treatment

Hyperacusis activities treatment approach involves both individualized counselling and sound therapy specific to hyperacusis.⁸

For home remedies, one should try some relaxation techniques for example breathing control exercises and muscle relaxation exercises. Many patients initially respond to hyperacusis by seeking protection with earplugs, earmuffs, or similar devices.¹ However, it is not advisable to use earplugs and muffs, and one should not try to avoid noisy areas as this will make you more sensitive to noise.⁵

Can hyperacusis be cured?

There is no cure for hyperacusis. However, it can be treated if it's caused by another condition, such as migraine, head injury or Lyme disease.⁵

When to seek medical attention

Visit your GP if everyday noises feel too loud or painful.

Summary

Hyperacusis is a hearing disorder characterised by an intolerance to sounds that most people find untroubling.^1,7 It can present with differing levels of severity and encompasses a broad array of responses to sound, categorized as excessive loudness, annoyance, fear, and pain.² While the exact cause of hyperacusis is unclear, it is known to be triggered by hearing sudden loud noises such as fireworks. 

It is also known to appear alongside other conditions such as tinnitus, head injury, Bell’s palsy, Lyme disease, migraines, Williams syndrome and autism.⁵ Unfortunately, hyperacusis has no cure, but it can be managed if it's caused by another condition, such as migraine, head injury or Lyme disease.⁵ Treatment for hyperacusis may include Informational and Educational Counseling, Cognitive Behavioral Therapy (CBT), sound therapy and Hyperacusis Activities Treatment.⁸