--What is Hyperacusis?

Imagine being at a movie where the sound track is turned to the highest volume. Actors' voices are screaming at you. After five minutes, you leave holding your ears and cursing the theater for its poor judgment.

Turning newspaper pages, running water in the kitchen sink, your child placing dishes and silverware on the table - all are intolerable to your ears. A baby cries or a truck screeches its brakes to a halt and the sound is excruciating. What has happened to my ears?


The person who has hyperacusis can't simply get up and walk away from noise. Instead, the volume on the whole world seems stuck on high. Hyperacusis is defined as a collapsed tolerance to normal environmental sounds. Ears also lose most of their dynamic range. What is dynamic range?

Dynamic range is the ability of the ear to deal with quick shifts in sound loudness. Suddenly everyday noises sound unbearably or painfully loud. The disorder is often chronic and usually accompanied by tinnitus (ringing in the ears), but can occur in patients who have little or no measurable hearing loss.

Hyperacusis differs from recruitment, which is an abnormal growth in the perception of loudness accompanied with hearing loss. With recruitment, loud noises are uncomfortable. With hyperacusis, all sounds are too loud.

Most patients also experience inner ear pain or a feeling of fullness (pressure) in the ears. This pressure in the ears can best be described as the feeling one normally gets when descending in an airplane. Hyperacusis can be devastating to the patient's career, relationships, and peace of mind. Finding the proper diagnosis is difficult because few doctors understand hyperacusis.

A LIFE ALTERING CONDITION

Hyperacusis makes living in this noisy world difficult and dramatically changes the patient's pattern of life. Moving about, traveling, and communicating with others is challenging. Ear protection must be worn in areas that seem too loud. This includes earplugs, industrial earmuffs or both if necessary.

Even then, many vocational and recreational activities must be curtailed or eliminated because, although protection reduces the noise entering the ears, it sometimes seems insufficient to block out certain frequencies or noise intensities.

The things most of us take for granted, such as driving a car, walking down the street, riding a bicycle, listening to the TV, stereo, someone speaking over a telephone or microphone, shopping, attending indoor events, dining at restaurants, taking vacations, or participating in group activities often are difficult or impossible. Many have difficulty using a vacuum cleaner, a hammer, a lawn mower, power tools, ride a motor boat or motorcycle.

Most jobs involve some level of noise. In some cases, the patient may need to seek other employment or attempt to secure disability with the help of an understanding doctor. Loud noise exposure generally makes the condition worse and exacerbates the accompanying tinnitus. Patients report they perceive sound - even their own voice - as uncomfortably loud and this not only causes tinnitus to increase but may also cause inner ear discomfort or a popping reflex in the ear. In fact some patients actually try to change the pitch of their own voice to accomodate their ears. This may help their ears but a patient can become hoarse in the process.

In cases not involving aural trauma to the inner ear, hyperacusis can also be acquired as a result of damage to the brain or the neurological system. In these cases, hyperacusis can be defined as a cerebral processing problem specific to how the brain perceives sound.

In rare cases, hyperacusis may be caused by a vestibular disorder. This type of hyperacusis, called vestibular hyperacusis, is caused by the brain perceiving certain sounds as motion input as well as auditory input. In some cases, vestibular hyperacusis can affect the autonomic system and cause problems such as loss of consciousness, mental confusion, nausea, or extreme fatigue.

This is a helpful pdf. to help explain hyperacusis further:

http://www.tinnitus.org.uk/files/hyperacusis.pdf

Hi Abishag, (((( Smiles ))))

Lets not also forget the catagories stages of hyperacusis listed on the hyperacusis network as well. Been through the all sounds being super loud to working my way up the chart.
Everybodies hyperacusis can present alittle differently read the board for years like you have going back to the 2001 posts the oldest posts there was back then to read on the board.
But pain can be a componet of hyperacusis read the link as well.
It's interesting that the doctor mentions about several theories about the underlining mechanism of H whilst none of the theories is entirely satisfactory though it's an emerging understanding and the loud discomfort test is not an estential test. I had that test and my H got worse and about the sound therapies thing slowly gentally reinducing sound into ones life thats what I did overtime sound therapies but disagree about not wearing any protection in the car ever as my hyperacusis disorder got really bad collapsed from going out and about from noise..
There is a crisis time with H. Lots of different opinions on that issue..
Do you wear any protection in the car and if you don't does your condition worsen from it or did it worsen at one time too???

Categories of Hyperacusis

Category 1

Hyperacusis has little impact on the patients life. Sounds reaching 80-85+ decibels require ear protection only because the patient feels they have sensitive hearing or it could damage their hearing. This patient may also feel inclined to protect their ears in loud environments because tinnitus (ringing in the ears) is noticeable after prolonged sound exposure. The patient may also feel some degree of fatigue after prolonged sound exposure or feel a slight pressure or feeling of fullness in their ears when sounds are near or above 85 decibels.

Category 2

Hyperacusis moderately impacts the patients life. Sounds at 65+ decibels (talking/normal conversation) are perceived as loud. The noise of mainstream living is challenging. The patient seeks controlled sound environments and starts interpreting all daily events in terms of the noise that might potentially be produced. Misophonia (dislike of noise) may become a problem or phonophobia (fear of noise). A feeling of fullness in the ears and/or burning at times is felt by the patient. It is critical that the patient seek help from a qualified hearing clinician who administers sound retraining therapy (TRT - Tinnitus Retraining Therapy). A patient's Loudness Discomfort Levels (LDL's) are established by the clinician and a protocol is prescribed to re-establish the patients sound tolerances.

Category 3

Hyperacusis is a significant problem. Sounds at 50+ decibels (background noise/soft music) are perceived as too loud. Mainstream living is very difficult and normal conversation is too loud. The patient seeks isolation not only dealing with their collapsed tolerance to sound and is very susceptible to phonophobia (fear of noise). The patient seeks controlled sound environments and interprets all daily events in terms of the noise that might potentially be produced. The patient has a tendency to wear ear protection too much which will tend to make their ears even more sound sensitive. A feeling of fullness in the ears and/or burning is very pronounced. By the end of the day they are exhausted from the sound they have endured trying to survive in their normal daily routine. It is critical that the patient seek help from a qualified hearing clinician who administers sound retraining therapy (TRT - Tinnitus Retraining Therapy). A patient's Loudness Discomfort Levels (LDL's) needs to be established by the clinician and a protocol prescribed to re-establish the patients sound tolerances. Anxiety, lack of sleep, pain in the ears are common and must be treated in addition to sound retraining therapy (TRT) for the patient to recover. Some patients need some short term help to sleep through the use of medication.

Category 4

Hyperacusis is at a crisis level. Sounds below or significantly below 50 decibels (whispering) are perceived as too loud. Mainstream living is not possible. The patient is isolated and barely able to communicate because they cannot even tolerate the sound of their own voice. Talking to others, speaking on the telephone, listening to television, running water, even the sound of wind outside is overwhelming for the patient. If catagory 4 severe hyperacusis comes on suddenly the patient's world is turned upside down. It is difficult for them to even live in the company of their family (particularly if there are small children). Women's voices are frequently difficult to tolerate because the tone of their voice is a higher frequency than mens. Some patients this severe may be able to produce audiograms proving they can hear at minus decibel levels. Anxiety, lack of sleep, depression, strong ear pain, and phonophobia are common problems due to severely collapsed tolerances to sound. Special considerations (over and above sound therapy) are needed to help this patient in crisis so they can slowly regain their tolerances to sound. Anxiety and sleep deprivation must be aggressively treated by the clinician so the patient can be motivated to start sound retraining therapy. Although medication is generally discouraged for hyperacusis patients it may be absolutely necessary on a short term basis to allow the patient to finally rest at night, reduce their anxiety level of dealing with the onslaught of all sounds being on a daily basis and see that there is light at the end of the tunnel. This is critical for this patient in crisis.


http://www.hyperacusis.net/hyperacusis/categories+of+hyperacusis/default.asp

Some additional information on Hyperacusis/Tinnitus--

Questions and Answers

What is hyperacusis?

Hyperacusis (Hyper-a-CU-sis) is a collapsed tolerance to normal environmental sound. All sounds are perceived as too loud. Also quick shifts in sound are difficult for the patient to tolerate.

Hyperacusis can occur in one or both ears. It can occur suddenly or over a period of time. It can be accompanied with or without hearing loss. If the hearing loss is significant the condition is called recruitment. If the hearing loss is minimal, typically it is referred to as hyperacusis.

Hyperacusis can also be accompanied by tinnitus (Tin-EYE-tus). Tinnitus is the perception of sound in the head when no outside sound is present. It is typically referred to as ringing in the ears but others may describe the sound as hissing, roaring, pulsing, whooshing, chirping, whistling or clicking have been described.

Is hyperacusis a common problem?
No. Hyperacusis is rare. The most common reaction to a noise injury is hearing loss and/or tinnitus. It has been commonly reported that 50 million people have tinnitus. A common report from the American Tinnitus Association (www.ata.org) has revealed that approximately 40% of tinnitus patients have some difficulty with hyperacusis. Actually 40% of tinnitus patients have sensitivity to sound but this is NOT hyperacusis. It is only when the patient has significant, pronounced sensitivity to sound where their loudness discomfort levels (LDLs) so collapsed that they impact their lives on a daily basis. True hyperacusis is so rare that most hearing doctors do not know of the condition and often subject the patient to hearing tests which further collapse the patients tolerance to sound. It is for this reason that a doctor must establish the patients LDLs before any hearing tests are administered.

Is hyperacusis a disease?
No. Just as a fever or headache accompanies many different illnesses, hyperacusis is a symptom. Although many times people complain of being sensitive to sound for a short period of time following a loud rock concert or while they have a migraine headache, this is not hyperacusis. Hyperacusis a symptom where the patients tolerance to sound does not improve. The most common cause is from a significant noise injury. Other causes of hyperacusis can come from Lyme disease, Bells Palsy, TMJ, drugs which are not ear friendly, irrigating (cleaning) the ears, Williams Syndrome, Meneires Disease, and just a host of other illnesses.

What causes hyperacusis?
There is speculation that the efferent portion of the auditory nerve has been affected (efferent meaning fibers that orginate in the brain which serve to regulate sounds). Others feel hyperacusis is a brain processing problem specific to how the brain perceives sound. Others feel it is a combination of both.

Why is my hyperacusis often worse when I wake up and before I go to bed?
Individuals with hyperacusis have ears that yearn for total silence. Night time is quiet time. After a full night of total quiet, it is often hard for the hyperacusis patient to face the noise of a new day. Some hyperacusis patients even wear ear protection at night and it even becomes more difficult to face the noise of a new day. This is just one example of why the patient is being given a wrong directive from their survival instinct and living in total silence is the wrong approach.

Hyperacusis patients also experience sound fatique. At the end of a day their ears are tired and less tolerant of noise. Almost all hyperacusis patients experience a symptom commonly referred to as fullness in the ears. It is a feeling where the patient feels pressure in the ear or the sensation that someone is actually pressing on their eardrum. Other patients feel pain or burning in the ears. From time to time doctors will tell the patient that the ears are incapable of experiencing pain. This is not true.

What should I do about my hyperacusis?
You should have a medical examination by someone who is knowledgeable about hyperacusis. There are very few doctors in the world that understand hyperacusis. As a starting point you can visit the website for the Tinnitus Retraining Therapy Association (http://www.tinnitus-pjj.com/referral.html). Individuals listed here also administer a retraining therapy which is similar to tinnitus retraining but is customized for the hyperacusis patient so they can re-establish their tolerances to sound.
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ABISHAG ~~
My personal experience is that my Hyperacusis/Tinnitus DID COME on me suddenly. However, it was almost 2 years after a brain aneurysm (surgery), that all of a sudden I couldn't understand WHY EVERYBODY OUTSIDE our home was talking SO LOUD! A few months later even our television was off-limits.

My husband watches the television with a special headset, so the sound is muted for me. He has sacrificed his entire lifestyle for me. Thank the Lord we both are Christians.

Going to church became unbearable. I still must wear ear protection 24/7's, yet compacted cotton balls work during the day. I must wear earplugs with a high decible level when I go outside of our home. There have been cases when I found I had to leave a grocery store. The banging of the shopping carts, and the intercom system was/is dreadful!

Taking an anti-anxiety medicine is NECESSARY! I use Xanax.

I have this condition in both ears along with the tinnitus. It fluctuates with the medication that I must take. The OTC Vinpocetine helps minimally with the ringing sound in my ears.

Also caffeine is not good. Yet, I enjoy coffee sometimes. As one Medical Doctor expressed, 'it's sometimes a toss-up', as what an individual can/will tolerate.

An acquaintance of mine had a bad case of bronchitis. It was following her several weeks of medical treatment that she became 80% deaf. She waiting too long to seek professional Medical help. Yet, she STILL has hyperacusis. It is the noice decible levels that offset her tolerance.

Pain is expressed differently for each person. Even the earplugs can cause the pain. Yet, we must deal with it as best we can. I know it is the grace of the Lord that I am still alive. Therefore,I must agree with King David, "Before I was afflicted I went astray; but now have I kept thy word."
In all things give thanks for this is the will of God in Christ Jesus concerning you." (Notice it says, "IN",and not "FOR".

I was not following the Lord's Word, yet I thought I was a Christian. I believed in the Lord Jesus. Jesus said, "Why do you call me Lord, and do not do the things I say?" I did a lot of soul-searching and HE FOUND ME. It was I who was lost, not the Lord Jesus.
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I once was lost and now I'm found was blind but now I see!
AMAZING GRACE!
JESUS IS LORD! JESUS IS OUR CREATOR! JESUS IS GOD! (Triune God)

HYPERACUSIS --What Can Be Done?
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The progression of hyperacusis is unpredictable. Many patients' tolerance improves while some cases grow steadily worse. The only factor we know of that unquestionably affects progression or regression is continued exposure to loud noise.

Proper guidelines must be followed especially when one first develops hyperacusis. The best source of information comes from The Hyperacusis Network. Many patients have seen improvement in sound tolerance through the use of sound generators (special hearing aids) that emit broad band pink noise. This retraining therapy suggests that the ear will become desensitized to sound by listening to broadband pink noise at barely audible levels for a disciplined period of time each day (usually 2-8 hours a day). This has been proven to help over 90% of hyperacusis patients maximize the tolerances in their ears. The name of this treatment is called Tinnitus (Hypeacusis)Retraining Therapy or TRT. To find a list of current hearing professionals who administer this treatment, go here:

Another method is to have the patient listen to a pink sound CD. To summarize, pink sound has been found to be very helpful in retraining ears to re-establish their tolerances to sound. This can be done through two delivery systems: special custom fitted hearing appliances called sound generators or listening to a CD player. These methods represent great hope and can help the hyperacusis patient but they are not a cure.

Individuals who suddenly come down with hyperacusis go through a distressing crisis period where it may be difficult for the patient to sleep restfully at night. Getting proper sleep and reducing stress levels are very important and some medication may initially be needed to help facilitate this.

The underlying reasons why some people are more susceptible to ear problems than others is not understood. Of the various catalysts for the onset of hyperacusis, noise is the most common and preventable one. Avoid loud sounds whenever possible and wear ear protection when needed.

Those who come down with hyperacusis may overprotect their ears because they have a fear of noise (phonophobia). For those who suddenly develop severe hyperacusis, it may be necessary to use ear protection so that the patient's ears have an opportunity to regroup and recover. After a few months however, over protection will only further collapse ones tolerance to sound. The patient is in a Catch 22 and walks a fine line between over protecting and under protecting their ears. Most, over a period of time learn to trust their instincts.

One major problem the hyperacusis patient must contend with are hearing professionals who, in their attempts to diagnose the problem, subject the patient to tests which involve loud sounds (MRI or BAER). Sound tolerances or LDL's (Loudness Discomfort Levels) must be known before an audiometric evaluation is performed. Some patients with hyperacusis have the ability to hear sounds at minus decibel levels. Many patients also complain of ear discomfort, a feeling of fullness or burning sensation in the ears. Some doctors have a hard time understanding this because they believe there are no nerve endings in the ears. This is just another area of misunderstanding between the doctor and the patient.
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This article taken from <www.hyperacusis.net>
The Hyperacusis Network

-Four Types of Sound Sensitivity--
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1. HYPERACUSIS: These individuals have a collapsed tolerance to normal environmental sound. The term commonly used to describe this condition is 'hyperacusis'. Hyperacusis can come on gradually or occur suddenly where the patient finds themself in a state of crisis. Patients who have a collapsed tolerance to sound need to have their Loudness Discomfort Levels (LDL's) established by a hearing healthcare professional. Normal LDL's are in the 85-90+ decibel range. Patients with hyperacusis would have LDL's well below that level. The common treatment for hyperacusis is listening to broadband pink noise though sound generators (special hearing aids) which must be ordered through a specially trained doctor or audiologist who administers Hyperacusis (Tinnitus) Retraining Therapy. The therapy often costs $3000-$4000 (depending on the clinician) and typically is not covered by insurance.

There are two basic ways to deliver broadband pink noise to your ears. The best way starts with a clinician who is trained to diagnose the seriousness of your condition, explain to you the dynamics of hyperacusis, test your ears in gentle ways to determine your loudness discomfort levels (LDL), fit you with special hearing aids called noise (sound) generators that deliver broadband pink noise to your ears, monitor your progress and provide directive counseling until you recover. Treatment usually lasts 6 months. Clinicians who administer this kind of treatment were trained by Dr. Pawel Jastreboff (Emory University in Atlanta, Georgia). They are experts in treating hyperacusis and tinnitus patients. Their protocol is called Tinnitus Retraining Therapy (also know as TRT) and it has significantly helped tinnitus and hyperacusis patients recover. To learn more about TRT you might consider reading Dr. Jastreboff's book "Tinnitus Retraining Therapy." A list of TRT clinicians can be seen by visiting this website: http://www.tinnitus-pjj.com/referral.html

The second way one can deliver broadband pink noise to their ears would be to purchase the broadband pink noise CD from the network. Instead of listening to broadband pink noise through special noise generators (TRT), a similar sound can be delivered to the ear by listening to a pink noise CD. With this method pink noise is delivered to the ears through a compact CD player (i.e. walkman). If you use a compact CD player it is very important that you use open air headphones. More detail is explained in the guideline that comes with this networks pink noise CD. Pink noise can also be downloaded from the pink noise CD to an ipod. The only caution here would be that the pink noise be converted to a WAV or AIFF format.

2. RECRUITMENT: There are many more individuals who have recruitment. Recruitment is the a rapid growth of perceived loudness for sounds in the pitch region of a person who has hearing loss. This phenomenon occurs because at some decibel level, the normal hair cells adjacent to the damaged hair cells (corresponding to the frequency of a hearing loss) are "recruited." At the decibel level at which these normal hair cells "kick in," perceived loudness shoots up rapidly, causing discomfort. In other words, at one point the person cannot hear the sound because they have hearing loss (in that frequency), then when the sound reaches a certain loudness and/or frequency the person is blown away. Once they finally hear the sound, it is perceived as far too loud. Recruitment is a common phenomenon in cultures where the majority of their lives have been saturated with too much noise – like our Western culture. Common treatment is the same as it is for hyperacusis unless the persons hearing loss is so pronounced that listening to broadband pink noise would be of no benefit to them.

3. HYPERSENSITIVE HEARING (OF SPECIFIC FREQUENCIES): Then there are individuals who are sound sensitive at birth but it is only specific to certain frequencies heard at loud levels (typically above 70 decibels). It may seem like we are splitting hairs here but remember – the key words with hypersensitive hearing are – sound sensitive to specific frequencies heard at loud levels. These frequencies are typically labeled 'problem' frequencies. Autistic children are good examples of this. They can tolerate some sound at normal or even loud volumes but some frequencies are difficult to tolerable. Commonly autistic children, children who are marginally autistic, or non-autistic individuals who have hyperacute hearing are treated with auditory integration therapy (AIT). AIT takes regular music and filters out the problem frequencies through a special machine called an audiokinetron. Somehow this therapy seems to 'retune' their ears and normalizes their hearing tolerances. The music is listened to at decibel levels which can peak up to 90 decibels. This creates a problem for the hyperacusis patient. The therapy is too loud and only worsens the condition of the hyperacusis patient whose Loudness Discomfort Levels have been compromised. To learn more about the sensory problems associated with autism visit this link: http://www.autismtoday.com/adviceforparents.pdf

4. PHONOPHOBIA/MISOPHONIA:

Phonophobia (fear of sound) is an adverse emotional response to sound and often develops with an individual who has a significant collapsed tolerance to sound. They not only fear the sound of the environment they are experiencing in real time (right now) they worry about the sound that future events of the day or in the near future will produce. It can significantly interfer with a patients recovery as they seek or complete sound therapy. Phonophobia can take over ones life and make one feel they need to isolate themselves to survive. This is a recipe for disaster. It is critical that we keep our ears active to rebuild our tolerances to sound. That is why broadband pink noise is so crucial to bringing us back to the mainstream of life.

Misophonia (dislike of sound) is also an adverse response to sound no matter what volume the sound is. Typically misophonia characterizes an individual who reacts strongly to soft sounds and sometimes is further triggered by seeing the source of the offending sound. Common examples would include but are not limited to: the sound of people eating, smacking their lips, sniffing, the sound of certain consonants like p, s, or t, and repetitive sounds. These individuals do not have a collapsed tolerance to sound which would be evident in a Loudness Discomfort Level (LDL) test.

Hyperacusis is a collapsed tolerance to normal environmental sounds. If the hyperacusis patient IS also dealing with phonophonia and/or misophonia then their clinician needs to address these issues in addition to treating the patient for hyperacusis. It is also important to note that a person can have phonophobia and/or misophonia and not have hyperacusis at all. Sound confusing. Let's talk...

Let's, for sake of further clarity, discuss come common examples of misophonia. They are not a separate catagory of sound sensitivity because the issues we are about to talk do not involve loud sounds. Some individuals are not sensitive to loud sounds (in other words they have normal loudness discomfort levels - LDL's) but they are unable to tolerate the sound of people eating or chewing. Oddly enough they have no problem tolerating the sound of their own eating. These individuals have a difficult time eating with their family and friends and some insist on eating all by themselves. They become irritated or enraged at meals and sometimes. This is not hyperacusis. The patients primary goal would be to neutralize or refocus the dislike they have of these specific sounds. Most of these individuals live very normal lives with the only exception of being unable to tolerate all the dynamics of other people eating. Often these individuals have been unsuccessful finding any information about this condition. To the best of our knowledge no articles have been written in any qualified medical journal and no studies or research has been done about this. Patients seeking treatment from their clinician may have to copy the information from this website to help their doctor understand what is taking place here. Treatment for these patients comes from clinicians who have a specific protocol for misophonia. Search the network message board using the word 'misophonia' to learn more about this problem and protocols suggested. Usually these individuals are sensitive to particular sounds which are not loud in volume. For example, some individuals have a hearing sensitivity to certain consonants (i.e. s, t, p, c). Once again, although this is a sound sensitivity issue, this is not hyperacusis. It is misophonia.

Misophonia is a symptom which is misunderstood. The word 'misophonia' was invented by Dr. Pawel Jastreboff to help clear some of the misunderstanding. Aside from a misophonia protocol it is not clear whether broadband pink noise helps the patient improve their dislike of sound. Some individuals with misophonia have been diagnosed with an obsessive compulsive disorder (OCD) and have sought treatment from a psychotherapist. To learn more about misophonia click on the link off our main menu on misophonia. Further resources include:

This is a link to a website dedictated to misophonia:

http://www.misophonia-uk.org/