Hearing sensitivity or hyperacusis can be extremely disturbing. Currently, there is no cure for hyperacusis and therefore, the condition has to be managed.

What is Hearing Sensitivity or Hyperacusis?

Hearing sensitivity or hyperacusis is a hearing disorder that affects one’s ability to deal with certain kinds of sounds. These sounds become unnecessarily hyped in the ear leading to discomfort even when others are unable to hear the sound. Sounds such as that of a car engine, the running tap, refrigerators, dishwashers, and other basic kitchen appliances. Loud discussions become relatively even louder in your ear.
Hyperacusis is not a common condition and affects only 1 in 50,000 people. This condition is often accompanied by another condition known as tinnitus—which is a ringing or buzzing sound in the ear. A lot of people suffering from hyperacusis also have normal hearing.
Depending on the severity of the hearing sensitivity, these sounds can have either mild or severe effects on the patient. In severe cases, the patient might suffer a loss of balance or seizures.
A person with a very good hearing of Hearing sensitivity (better than normal) below 0 dB HL can be referred to as hypersensitive. However, this case is normal and not hyperacusis. Hyperacusis is usually not associated with this kind of hypersensitivity. Therefore, there is a need to differentiate hyperacusis from normal hearing sensitivity.
There are different types of hyperacusis and for a clearer understanding of the different types, we need to focus on the following terminologies:

• Annoyance

• Fear

• Loudness and

• Pain

These four groups cover the ways hyperacusis is perceived generally. They also cover the various ways in which different people react to hyperacusis while creating a meaningful distinction among them.
While some people with hyperacusis experience these signs singly, others may experience two or more signs at a time. The perception of loud noise can be considered as a basic primary psychoacoustical response. Fear and annoyance can be referred to as personal emotional reactions to hearing sensitivity. Pain hyperacusis can be used to refer to either of the two conditions or both of them. These terminologies are used to precisely differentiate between the types of hyperacusis. Nonetheless, hyperacusis or hearing sensitivity is the general terminology used for the condition.

 

Types of Hyperacusis

Loudness Hyperacusis

When we talk of loudness hyperacusis, we refer to the condition whereby moderate sounds is perceived to be very loud when compared to a person with normal hearing would hear.

Annoyance Hyperacusis

When negative emotional reactions accompany sounds, this can be referred to as annoyance hyperacusis. This reaction arises from the perception of the sound as very loud though not in all cases. This kind of reaction may be related to a particular sound or different kinds of sounds. This sound is perceived to be pervasive and persistent as opposed to the normal reaction from disturbing sounds like one from a loud playing irritating music. Annoyance hyperacusis can be manifested in the form of anxiety, irritation, and tension.

 

Fear Hyperacusis

Fear hyperacusis refers to the aversive response to a particular sound or group of sounds. This kind of response leads to preventive response and avoidance behavior. In the case of fear hyperacusis, the individual will take steps to avoid circumstances that lead to exposure to certain kinds of sound. People also tend to avoid places where they might be exposed to certain kinds of sounds. These include places like restaurants, sporting arenas, restaurants, and even recreational centers. In some cases, they tend to avoid even normal social gatherings.

 

Pain Hyperacusis

When a patient with hyperacusis experiences pain when exposed to a much lower sound level, this is referred to as pain hyperacusis. This low sound level can be around 120 dB SPL. In some cases, this sound is reported as a stabbing sound in the head or the ear. The pain sometimes appears severe. Whether this pain occurs as a result of lowering of the normal hearing threshold or a different mechanism of sound processing is not clear. When discussing pain hyperacusis, care should be taken to distinguish between those with a painful ear infection and pain hyperacusis.

 

Causes of hyperacusis

Sounds are perceived by the ears as vibrations. In people suffering from hyperacusis, the ear confuses or amplifies certain vibrations. So even when a person with hyperacusis receives the same with a person with normal hearing, their brain has a different reaction to the sound. This is the cause of the discomfort the person with hyperacusis feel.
Normally, there is nobody born with hyperacusis. This condition is usually caused by certain health challenges or diseases. Some of the most common causes of hyperacusis include the following:

• A head injury can lead to hyperacusis: This is most common in the case of an airbag injury or a fall.

• Toxins and other forms of harmful medication: some medications known as ototoxic medications can cause damage to the ear. These kinds of medication can lead to hyperacusis.

• Bell’s palsy: this is a viral infection that affects the inner ear and even the facial nerves.

• Adisorer of the temporomandibular (TMJ) joint.

• Migraine

• Regular use of valium

• Lyme disease

• Some kinds of Epilepsy can cause hyperacusis

• Taye-Sachs disease

• Chronic fatigue syndrome

• Autism

• Depression

• Meniere's disease

• Post-traumatic stress disorder (PTSD)

 Constantly hanging around areas prone to loud noises can be a major cause of hyperacusis. Some kinds of noise, for instance, a single sharp gunshot that is loud enough can be a trigger for the condition. Prolonged use of earbuds at exceedingly high volume can lead to the condition after some time.

Influence of Hyperacusis

Hyperacusis or hearing sensitivity leads to reduced tolerance to sound. People with hyperacusis are often confined in their homes. They don’t like going out to social gatherings. Hearing sensitivity if not treated can slowly begin to affect one’s career and life generally.
In some cases, even the basic things such as using the kitchen blender, the running of the car engine, doing the lawn and even using the washing machine become very loud for the affected individual. Directly or indirectly, this will affect the way they handle those activities.

Diagnosis and the treatment of Hyperacusis

Without proper knowledge of the causes of hearing sensitivity, it becomes very difficult to provide the right remedy for it. According to the American Speech-Language-Hearing Association, various conditions can lead to hearing sensitivity. Conditions such as the ones we mentioned earlier. Therefore, a proper diagnosis must precede the treatment of hearing sensitivity.

·        Diagnosis

Have you had experienced some of the signs of hyperacusis or perhaps you feel you may be suffering from the condition? The first thing to do is to visit an ENT unit of a hospital to see a specialist in hearing problems. ENT doctors are found in most large clinics that offer ear examination as part of their services.
One of the things the doctor will enquire from you is your medical history. This will help the doctor to ascertain the best kind of test for you. He will also carry out a test on the affected ear. This test will help to ascertain whether or not the patient is truly suffering from hyperacusis.
Carrying out a test will also help identify what kind of hyperacusis the patient is suffering from. A proper test is a guide to the doctor whose duty is to ensure that you live a longer and happier life.
In the case of loudness hyperacusis Audiologists can diagnose the condition by taking measurements of loudness growth or discomfort levels of loudness by the use of pure tones. This diagnosis can also be carried out by the use of recorded environmental sounds as proposed by hearing healthcare literature studies.
Exposing patients to sound levels of 60 to 70 dB and verifying from them when the sound becomes too loud can be a valuable way to indicate if they have hyperacusis or not.

·        Treatment

Naturally, hearing sensitivity or hyperacusis that is caused by damage to the inner ear or aging cannot be cured. Once it has started, it can only be managed. Nevertheless, there are exceptions to this.
Treatment of hyperacusis or hearing sensitivity depends on the causes of hearing sensitivity. For example, in the case of a loud gunshot very close to the ear. Naturally, some kinds of hyperacusis will get better on their own over time without the need for treatment. In most cases where the sensitivity is caused by an injury to the head or the ear, the person naturally gets better after the injury is treated.

• Sound desensitization

For a hyperacusis or hearing sensitivity that does not get better on its own after some time, the doctor might recommend a treatment known as sound desensitization. You will be introduced to a specialist whose job is to teach you how to deal with sound. In short, sound desensitization involves the reintroduction of everyday sound afresh.
The patient will be made to listen to a very quiet sound daily and slowly the specialist will increase the sound to a much louder one.
This kind of treatment is mostly carried out with a device you wear on the affected ear. The sound used in this treatment is not a worrisome one. Static sounds are used. This kind of treatment can take up to 6 months or one year before the patient reaps all the benefits of the therapy.
There are other kinds of treatment used for hyperacusis which include relaxation exercise and acupuncture. However, enough research has not been carried out to determine how effective these methods of treatment are.

• Auditory Integration Therapy

There is another form of experimental treatment known as Auditory Integration Therapy (AIT). This kind of treatment is usually used in autism patients.  It involves playing and listening to music at different volumes at certain periods daily.
The hearing specialist may also place you on mediation to help you cope with the stress caused by hearing sensitivity.

• The use of hearing protection/ earplugs in a noisy environment

Most people with hyperacusis would tend to use earplugs to prevent them from loud sounds. Others might want to stay away from conditions and places with loud sounds. This may provide short term relief. However, if not treated for a long time, it will cause the condition to worsen. This is because the moment you are no longer wearing your earplugs, you will perceive sounds even much louder.

• Tinnitus retraining therapy

This form of therapy uses special devices known as noise generators. Wearing this device frequently will gradually reduce your sensitivity to noise. This deice slowly gets your ear accustomed to barely audible white noises it produces. Slowly, the ear will also learn to ignore such noises.

• Find someone to talk to about the symptoms you experience

Talking to someone will not directly provide a cure for hyperacusis. However, it can be a good way of dealing with other conditions associated with hearing sensitivity such as increased anxiety. In cases where there is heightened anxiety or reactions, talking to someone might be of help. You don’t just talk to anyone but rather a professional such as a psychologist or a counselor. They can work with you in identifying the factors that trigger your anxiety and help you with ways of dealing with those factors. With a good understanding that hyperacusis is not caused by a threatening disorder can be a good way to improve a patient's tolerance to sounds considerably.
 
 

• Remind people of your condition and tell them to avoid raising their voice

Always let people know of your condition so they can lower their voices when speaking to you. They should be fully aware that loud noise causes irritation to your ear and makes the message unclear. Lowering their voices will help you understand and cope with the conversations better.

• Using Cognitive Behavioral Therapy (CBT)

CBT involves changing the way you think about things. Inversely, changing the way your hyperacusis can help reduce anxiety and help you manage your hyperacusis better.

Where can you get help for hyperacusis?

1. Visit a General Practitioner (GP) or your family doctor

The first place to seek help during hyperacusis is with your family doctor or a general practitioner (GP). He will interview your medical history and try to find out the causes of your hearing sensitivity. In most cases, he is also in charge of treatment and providing remedies for hyperacusis. In some cases, the GP might refer you to an ENT doctor depending on his examination and findings.

2. The Ear, Nose and Throat Doctor (ENT)

The ENT doctor specializes in the treatment of conditions associated with hearing, the nose, and the throat. His duties are to carry out further tests on a patient using special and more advanced tools. Most cases of hearing problems such as tinnitus and hyperacusis are handled by him. Once he identifies the root cause(s) of your hearing sensitivity, he can proceed with the right therapy to make you feel better.

3. The Audiologist

The audiologist is a hearing scientist who is saddled with the responsibility of working with people with different kinds of hearing problems. He has a deeper understanding of what happens during a hearing problem. He is also responsible for providing hearing solutions such as recommending the right hearing aids and earplugs for people with hearing problems. A patient with hyperacusis will certainly get help when they visit an audiologist.

4. Visit an association such as the tinnitus association

Different countries have special associations devoted to providing help for people with conditions such as tinnitus, hyperacusis and other such related conditions. You can get help by visiting such organizations when you notice any of the symptoms of hearing sensitivity. They can also refer you to where you can get the proper treatment for your condition. If you are lucky, you might even get a free consultation and assistance with treatment.

Hyperacusis and Tinnitus

Some patients diagnosed with hearing sensitivity also suffer from tinnitus. While these two conditions may be related, they are two different conditions. According to research carried out by Dr. Jennifer R. Melcher Ph.D. and her colleagues, an associate professor of otology and laryngology at Harvard University Medical School, patients with tinnitus when tested for loudness discomfort levels find it difficult to bear very loud sounds.
According to Dr. Jennifer Melcher, people with tinnitus have more hyperacusis or hearing sensitivity. She is also of the view that in the evaluation of patients with tinnitus, the doctor should enquire from those with tinnitus about the loudness discomfort. Again, she also encourages doctors to evaluate patients who have showed signs of hyperacusis or hearing sensitivity for tinnitus as well.
Tinnitus can also be noticed in people with hyperacusis. Some patients with tinnitus agree that loud noises tend to worsen their tinnitus. Classifying this symptom as hyperacusis is not correct. While the treatment of hyperacusis may be rooted in the management of tinnitus, the two conditions remain entirely dissimilar. In the case of tinnitus, the affected patient perceives sound even when there is no external sound or stimulus to the ear. On the other hand, hyperacusis is the overreaction to external sounds.
While in the case of tinnitus there is no sound, for hyperacusis there must be an external sound that is wrongly perceived by the ear.
Tinnitus is a hearing sensitivity that is related to suffering. In some cases, this situation can be severe enough to prevent work. When talking about tinnitus, sensitivity and suffering account for two separate aspects of the condition and must not be confused with each other.
When we talk of tinnitus sensitivity, we refer to the perception of sound when there is no sound as we earlier mentioned. This can be either subjective or objective. The objective case is a rare occurrence. It happens when there is an internal auditory stimulus in the inner ear, for instance, a tempestuous blood flow in one of the arteries near the ear. This can cause the patient to hear a pulsing sound. This sound can also be head by a doctor using a stethoscope.
In the case of subjective tinnitus, there is mostly no external auditory stimulus. Only the patient can hear the sound. Patients with subjective tinnitus will describe the sensation they hear in one of the following ways:

• Ringing sound

• Buzzing sound

• Hissing sound

• Humming sound or

• Whistling sound

There are a lot of people with tinnitus that also suffer a hearing loss that is measurable with an audiometer. However, there are a lot of people suffering a hearing loss that do not have tinnitus.

Conclusion

While hyperacusis is not a common condition, it can be found in both adults and children. Hyperacusis can be related to many known causes and however, most cases also have no known causes. While we highlighted some of the major causes of hyperacusis in our discussion, there is still a need for further research to ascertain other causes of hyperacusis.
It is often a general practice for people with some form of hearing alteration including hyperacusis to use ear protection. While this may have some short term remedy, it is often not advisable to use ear protection all day long. When ear protections are overused, they can have a long term counter effect. They can cause lead to greater sensitivity to sound in patients with hyperacusis.
Ear protection such as earplugs should only be used when performing certain activities such as mowing the lawn or using the washing machine. Ear protection will not help in managing hyperacusis in the long run.
It is important to talk to the hearing professional from time to time for the best ways to manage your hyperacusis. It is also important to avoid the use of unsolicited drugs and self-medication in the treatment of the condition. It can be beneficial to try out some relaxation techniques to help you cope with hyperacusis. Relaxation techniques such as yoga and meditation are recommended.