Hyperacusis is the increased sensitivity to sound and a low tolerance for environmental noise.
Definitions of hyperacusis can vary significantly;
it can refer to normal noises being perceived as: loud, annoying, painful, fear-inducing, or a combination of those,
and is often categorized into four subtypes: loudness, pain, annoyance, and fear.
It can be a highly debilitating
hearing disorder.
Hyperacusis is often coincident with
tinnitus
Tinnitus is the perception of sound when no corresponding external sound is present. Nearly everyone experiences a faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearin ...
.
The latter is more common
and there are important differences between their involved mechanisms.
Little is known about the
prevalence
In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...
of hyperacusis, in part due to the degree of variation in the term's definition.
Reported prevalence in children and adolescents ranges from 3% to 17%.
Signs and symptoms
In hyperacusis, the symptoms are ear pain,
annoyance
Annoyance is an unpleasant mental state that is characterized by irritation and distraction from one's conscious thinking. It can lead to emotions such as frustration and anger
Anger, also known as wrath or rage, is an intense emotion ...
, distortions, and general intolerance to many sounds that most people are unaffected by.
Crying spells or
panic attack
Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, sweating, chest pain or chest discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a feeling of impending doom or of losing ...
s may result from the experience of hyperacusis. It may affect only one or both ears. Hyperacusis can also be accompanied by
tinnitus
Tinnitus is the perception of sound when no corresponding external sound is present. Nearly everyone experiences a faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearin ...
. Hyperacusis can result in
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil
Turmoil may refer to:
* ''Turmoil'' (1984 video game), a 1984 video game released by Bug-Byte
* ''Turmoil'' (2016 video game), a 2016 indie oil tycoon video ...
,
stress and
phonophobia. Avoidant behavior is often a response to prevent the effects of hyperacusis and this can include avoiding social situations.
Loudness Hyperacusis
Hyperacusis is most often characterized by a sensitivity to sound, where the perception of loudness is much greater than for a typical person; it is often associated with certain volumes and/or frequencies. Hyperacusis can occur in children and adults, and can be either "short-term" in a duration of weeks to less than a year before recovery, or, less-commonly, "long-term", spanning years and in some cases becoming permanent. Sensitivity is often different between ears.
Noxacusis (Pain Hyperacusis)
In some instances, hyperacusis is accompanied by pain, which is known as noxacusis. Noxacusis is characterized by pain resulting from sounds, often initiated at certain volumes or frequencies; pain can be immediate or delayed, and sometimes persists for an extended period of time following exposure.
Pain can be acute or chronic, and is often described as stabbing, burning, acid, or nerve pain, and is sometimes equated with the pain of a root canal or a broken tooth.
Loudness Discomfort Level (LDL)
The threshold of sound at which discomfort is initially experienced; measured in decibels (dB).
Setback
After a period of some relief from symptoms, discomfort resumes; often resulting from exposure to sound, or, in some cases, ototoxic medications or injuries. Setback prevention is an important focus among those affected.
Associated conditions
Some conditions that are associated with hyperacusis
include:
*
Acoustic shock
Acoustic shock is the set of symptoms a person may experience after hearing an unexpected, loud sound. The loud sound, called an acoustic incident, can be caused by feedback oscillation, fax tones, or signalling tones. Telemarketers and call ce ...
*
Adverse drug reaction
An adverse drug reaction (ADR) is a harmful, unintended result caused by taking medication. ADRs may occur following a single dose or prolonged administration of a drug or result from the combination of two or more drugs. The meaning of this term ...
*
Anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil
Turmoil may refer to:
* ''Turmoil'' (1984 video game), a 1984 video game released by Bug-Byte
* ''Turmoil'' (2016 video game), a 2016 indie oil tycoon video ...
*
Asperger's Syndrome
Asperger syndrome (AS), also known as Asperger's, is a former neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavi ...
*
Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inap ...
*
Autism spectrum
The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
*
Bell's palsy
*
Depression
*
Endolymphatic hydrops
*
Fetal Alcohol Spectrum Disorder
*
Hypothyroidism
Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as ...
*
Lyme disease
Lyme disease, also known as Lyme borreliosis, is a vector-borne disease caused by the '' Borrelia'' bacterium, which is spread by ticks in the genus '' Ixodes''. The most common sign of infection is an expanding red rash, known as erythema ...
*
Migraine
Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few ho ...
*
Ménière's disease
Ménière's disease (MD) is a disease of the inner ear that is characterized by potentially severe and incapacitating episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Typically, only one ear is affected initi ...
*
Multiple sclerosis
*
Noise-induced hearing loss
Noise-induced hearing loss (NIHL) is a hearing impairment resulting from exposure to loud sound. People may have a loss of perception of a narrow range of frequencies or impaired perception of sound including sensitivity to sound or ringing ...
*
Posttraumatic stress disorder
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...
* Severe
head trauma
A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of in ...
*
Sjögren syndrome
Sjögren syndrome or Sjögren's syndrome (SjS, SS) is a long-term autoimmune disease that affects the body's moisture-producing (lacrimal and salivary) glands, and often seriously affects other organ systems, such as the lungs, kidneys, and nerv ...
*
Superior canal dehiscence syndrome (SCDS)
*
Systemic lupus erythematosus (SLE)
Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Comm ...
*
Tay–Sachs disease
*
Tinnitus
Tinnitus is the perception of sound when no corresponding external sound is present. Nearly everyone experiences a faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearin ...
*
Tonic tensor tympani syndrome
*
Visual snow
*
Williams syndrome
Williams syndrome (WS) is a genetic disorder that affects many parts of the body. Facial features frequently include a broad forehead, underdeveloped chin, short nose, and full cheeks. Mild to moderate intellectual disability is observed in people ...
Causes
The most common cause of hyperacusis is overexposure to excessively high
decibel (
sound pressure
Sound pressure or acoustic pressure is the local pressure deviation from the ambient (average or equilibrium) atmospheric pressure, caused by a sound wave. In air, sound pressure can be measured using a microphone, and in water with a hydrophon ...
) levels.
Some affected people acquire hyperacusis suddenly as a result of taking ear sensitizing drugs,
Lyme disease
Lyme disease, also known as Lyme borreliosis, is a vector-borne disease caused by the '' Borrelia'' bacterium, which is spread by ticks in the genus '' Ixodes''. The most common sign of infection is an expanding red rash, known as erythema ...
,
Ménière's disease
Ménière's disease (MD) is a disease of the inner ear that is characterized by potentially severe and incapacitating episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Typically, only one ear is affected initi ...
,
head injury
A head injury is any injury that results in trauma to the skull or brain. The terms ''traumatic brain injury'' and ''head injury'' are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of in ...
, or surgery. Others are born with sound sensitivity, develop
superior canal dehiscence syndrome, have had a history of
ear infections, or come from a family that has had hearing problems.
Bell's palsy can trigger hyperacusis if the associated flaccid paralysis affects the
tensor tympani, and
stapedius, two small muscles of the
middle ear
The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear).
The mammalian middle ear contains three ossicles, which transfer the vibrations of the eardrum into waves in ...
.
Paralysis of the stapedius muscle prevents its function in dampening the oscillations of the
ossicles, causing sound to be abnormally loud on the affected side.
Age may also be a significant factor .
Some
psychoactive drugs such as
LSD,
methaqualone
Methaqualone is a hypnotic sedative. It was sold under the brand names Quaalude ( ) and Sopor among others, which contained 300 mg of methaqualone, and sold as a combination drug under the brand name Mandrax, which contained 250 mg met ...
, or
phencyclidine
Phencyclidine or phenylcyclohexyl piperidine (PCP), also known as angel dust among other names, is a dissociative anesthetic mainly used recreationally for its significant mind-altering effects. PCP may cause hallucinations, distorted percepti ...
can cause hyperacusis.
An
antibiotic
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy, ...
,
ciprofloxacin, has also been seen to be a cause, known as ''ciprofloxacin-related hyperacusis''.
Benzodiazepine withdrawal syndrome
Benzodiazepine withdrawal syndrome often abbreviated to benzo withdrawal or BZD withdrawal is the cluster of signs and symptoms that may emerge when a person who has been taking benzodiazepines, either medically or recreationally develops a phys ...
is also a possible cause.
Over-protection (e.g. by wearing earmuffs and/or ear plugs in normal sound environments) may also cause hyperacusis.
Neurophysiological mechanisms
As one important mechanism, adaptation processes in the auditory brain that influence the dynamic range of neural responses are assumed to be distorted by irregular input from the inner ear. This is mainly caused by hearing loss related damage in the inner ear.
The mechanism behind hyperacusis is not currently known, but it is suspected to be caused by damage to the inner ear and
cochlea
The cochlea is the part of the inner ear involved in hearing. It is a spiral-shaped cavity in the bony labyrinth, in humans making 2.75 turns around its axis, the modiolus. A core component of the cochlea is the Organ of Corti, the sensory org ...
. It is theorized that type II afferent fibers become excited after damage to hair cells and synapses, triggering a release of ATP in response. This release of ATP results in pain, sound sensitivity, and cochlear inflammation.
Diagnosis
The basic diagnostic test is similar to a normal
audiogram. The difference is that additionally to the hearing threshold at each test frequency also the lowest uncomfortable sound level is measured. This level is called ''loudness discomfort level'' (LDL), ''uncomfortable listening level'' (UCL), or ''uncomfortable loudness level'' (ULL). In patients with hyperacusis this level is considerably lower than in normal subjects, and usually across most parts of the auditory spectrum.
Treatment
Avoidance and Hearing Protection
Setback prevention and reduction of pain symptoms are high priorities among those with hyperacusis and noxacusis, which is often managed through a combination of controlling the environment so as to avoid loud sounds,
soundproofing
Soundproofing is any means of impeding sound propagation. There are several basic approaches to reducing sound: increasing the distance between source and receiver, decoupling, using noise barriers to reflect or absorb the energy of the sound w ...
, and wearing hearing protection, such as
earplug
An earplug is a device that is inserted in the ear canal to protect the user's ears from loud noises, intrusion of water, foreign bodies, dust or excessive wind. Since they reduce the sound volume, earplugs are often used to help prevent hearing ...
s and/or safety
earmuffs
Earmuffs are clothing accessories or personal protective equipment designed to cover a person's ears for hearing protection or warmth. They consist of a thermoplastic or metal head-band that fits over the top or back of the head, and a cushion ...
, such as the type used at firing ranges or industrial applications
Diet
Diet may play a role in symptom management in some cases of hyperacusis, with response to a migraine diet, low-histamine diet, or low sodium diet.
Sound Therapy
Sound therapy is sometimes recommended for those with hyperacusis, though its application among those with pain (noxacusis) should be used with caution.
Tinnitus retraining therapy, a treatment originally used to treat tinnitus, uses broadband noise to treat hyperacusis.
Pink noise
Pink noise or noise is a signal or process with a frequency spectrum such that the power spectral density (power per frequency interval) is inversely proportional to the frequency of the signal. In pink noise, each octave interval (halving ...
can also be used to treat hyperacusis. By listening to broadband noise at soft levels for a disciplined period of time each day, some patients can rebuild (i.e., re-establish) their tolerances to sound.
More research is needed on the efficacy of sound therapy techniques when hyperacusis is the primary complaint, rather than a secondary symptom, indicating that "no strong conclusions can be made" about its efficacy at this time.
Cognitive Behavioral Therapy
Another possible treatment is
cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (su ...
(CBT), which may also be combined with sound therapy.
However, randomized controlled trials with active control groups are still needed to establish the effectiveness of CBT for hyperacusis and the usefulness of CBT for noxacusis (pain hyperacusis) is not yet demonstrated in the scientific literature.
Society and culture
Notable cases
* Musician Jason DiEmilio, who recorded under the name
Azusa Plane
The Azusa Plane was the psychedelic music recording and performance project of Jason DiEmilio (1970 – 2006) of Clifton Heights, Pennsylvania. Performing almost exclusively on a Fender guitar and usually through echo effects, DiEmilio released ...
, had hyperacusis and ultimately went on to commit suicide due in part to his sensitivity to noise.
* Musician
Stephin Merritt has monaural hyperacusis in his left ear, which influences the instrumentation of his band,
The Magnetic Fields, leads him to wear earplugs during performances and to cover his affected ear during audience applause.
* Musician
Laura Ballance of
Superchunk
Superchunk is an American indie rock band from Chapel Hill, North Carolina, United States, consisting of singer-guitarist Mac McCaughan, guitarist Jim Wilbur, bassist Laura Ballance, and drummer Jon Wurster. Formed in 1989, they were one of t ...
has hyperacusis and no longer tours with the band.
* American politician, activist, and film producer
Michael Huffington has mild hyperacusis and underwent sound therapy after finding that running tap water caused ear pain.
*
Vladimir Lenin
Vladimir Ilyich Ulyanov. ( 1870 – 21 January 1924), better known as Vladimir Lenin,. was a Russian revolutionary, politician, and political theorist. He served as the first and founding head of government of Soviet Russia from 1917 to 1 ...
, the Russian
communist
Communism (from Latin la, communis, lit=common, universal, label=none) is a far-left sociopolitical, philosophical, and economic ideology and current within the socialist movement whose goal is the establishment of a communist society, a ...
revolutionary, politician, and
political theorist
A political theorist is someone who engages in constructing or evaluating political theory, including political philosophy. Theorists may be academics or independent scholars. Here the most notable political theorists are categorized by their ...
, was reported seriously ill by the latter half of 1921, having hyperacusis and symptoms such as regular headache and insomnia.
* Musician
Chris Singleton had hyperacusis, but made a full recovery.
* Musician
Peter Silberman
Peter Silberman (born March 31, 1986) is a Brooklyn-based songwriter, vocalist, and guitarist. He is best known as a member of the rock band The Antlers. In 2017 he released a solo album, '' Impermanence''.
Musical career
Silberman grew up ...
of
The Antlers had hyperacusis and
tinnitus
Tinnitus is the perception of sound when no corresponding external sound is present. Nearly everyone experiences a faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearin ...
which put his musical career on hold, until the conditions reduced down to a "manageable level". He has now resumed his musical career.
* Voice actor
Liam O'Brien has hyperacusis, and was insomniac as a consequence.
* In April 2021, Internet personality, singer-songwriter and voice actor
Tay Zonday stated that he has "debilitating
autistic
The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
hyperacusis".
* Noelle Foley developed hyperacusis after getting a concussion and neck injury on a roller coaster.
See also
*
Misophonia
*
Otoacoustic emission
*
Sensory processing sensitivity
*
Recruitment (medicine)
External links
Hyperacusis Research
References
Further reading
*
*
{{Authority control
Psychoacoustics
Diseases of the ear and mastoid process
Audiology
Rare diseases