What is Hyperacusis?

Hyperacusis is a rare hearing disorder. People with hyperacusis experience a hypersensitivity to sound, often hearing normal sounds as uncomfortably or unbearably loud. The condition may also be referred to as decreased sound tolerance (DTS). Most people experience sound in varying degrees, whereas someone with hyperacusis experiences sound at one sustained volume of uncomfortable loudness.

Hyperacusis often occurs alongside tinnitus, which is experienced as a constant ringing, whistling, clicking, or roaring in the ear. Examples of normal sounds in daily life that may range from aggravating to unbearable include:

• People talking
• Water running in the sink
• The humming of a car engine
• Electrical appliances running
• Someone turning the pages of a book or magazine

Since the experience of noise can feel so uncomfortable, it often takes a toll on a person’s mental health. Many people who suffer from hyperacusis will avoid stimuli that feels unbearable, which might include disengaging or distancing socially. This can lead to depression and loneliness. The constant irritability experienced by the loudness of sound can also lead to chronic anxiety.

Hyperacusis symptoms vary between individuals and healthcare professionals are still trying to find a universal way to screen for and measure the severity of hyperacusis symptoms.

Signs and Symptoms

Symptoms of hyperacusis vary between individuals. Symptoms can range from mildly irritating to unbearably loud, painful, or frightening. Depending on the severity of symptoms, some people may lose their balance or even have seizures due to how the sound is experienced. Other common symptoms include:

• Ringing in the ear
• Ear pain
• Sensation of fullness or pressure in the ear

Unfortunately, because of the constant and often intense experience of sound, hyperacusis can lead to:

• Anxiety
• Depression
• Social isolation
• Loneliness
• Avoidance
• Relationship issues

Causes

Hyperacusis does not have a singular cause. Specific causes are still being researched, but several theories exist regarding what might lead to the development of hyperacusis. Researchers have suggested that hyperacusis may develop when the auditory or facial nerves become damaged. This may occur after an illness such as Bell’s Palsy, Ramsay Hunt syndrome, or Lyme disease.

Researchers also believe it is possible brain structures that control how you perceive stimulation are making the sound seem louder. Additionally, research has found other contributing factors that may contribute to developing hyperacusis. These factors include:

• Chronic exposure to loud noises (i.e., rock musicians or construction workers)
• Exposure to sudden loud noises (i.e., airbag deployment, fireworks, gunshots, etc.)

Hyperacusis is often accompanied by other conditions or issues including:

• Anxiety
• Depression
• Autism
• Bell’s palsy
• Tinnitus
• Williams syndrome
• Down syndrome
• Ear infections (otitis media)
• Head injury
• Lyme disease
• Ménière’s disease
• Migraines
• Post-traumatic stress disorder (PTSD)
• Ramsay Hunt syndrome
• Superior Canal Dehiscence Syndrome (SCDS)
• Temporomandibular joint syndrome (TMJ)

Additionally, some people develop hyperacusis following surgery or while taking certain medications.

Risk Factors

There are several factors that may put someone at risk for developing hyperacusis. Risk factors may include:

• Chronic exposure to loud noises (i.e., rock musicians or construction workers)
• Exposure to sudden loud noises (i.e., airbag deployment, fireworks, gunshots, etc.)
• Aging
• Bell’s palsy
• Tinnitus
• Williams syndrome
• Down syndrome
• Ear infections (otitis media)
• Head injury
• Lyme disease
• Ménière’s disease
• Migraines
• Post-traumatic stress disorder (PTSD)
• Ramsay Hunt syndrome
• Superior Canal Dehiscence Syndrome (SCDS)
• Temporomandibular joint syndrome (TMJ)

Diagnosis

Diagnosis for hyperacusis can be difficult, as doctors are still trying to develop a universal way to screen for it and measure symptom severity. Symptoms vary between individuals, which can also make diagnosis more difficult. Doctors who are unfamiliar with hyperacusis may refer you to an ENT (ear, nose, and throat doctor) or to an audiologist. Diagnostic measures usually include:

• Medical history. Your doctor will take a full medical history, including family medical history. Your doctor will also ask questions regarding exposure to loud noises, any damage to your hearing, or if there have been any ongoing mental health concerns.
• Physical exam. Your doctor will assess for any structural damage to your ear that may be causing symptoms of hyperacusis.
• Hearing tests. These tests will allow your doctor to determine your hearing levels. Your doctor may also test to assess your loudness discomfort level.

If your doctor suspects that your symptoms are due to another medical condition, lab work may be ordered to rule those conditions out. Additionally, if it is suspected that your symptoms may be due to structural issues, your doctor may recommend imaging tests.

Treatment

There is no cure for hyperacusis, but there are ways to help manage symptoms and restore quality of life. Treatment options include certain therapies (behavioral, cognitive, tinnitus retraining therapy, or acoustic/auditory therapies), using wearable devices meant for sound desensitization, medications for sleep or mood regulation, loud sound avoidance, or surgery. Most people with hyperacusis benefit from a combination of treatments. Consult with your healthcare provider to determine what treatment approach is best for you.

Prevention

There is no known way to prevent hyperacusis, but there are certain measures that can be taken to reduce the risk of developing it. Measures include:

• Wearing protective earwear to minimize exposure to loud sounds that may cause hearing damage
• Limit your time spent exposed to loud sounds
• Manage your physical and mental health
• Be aware of family medical history

Complications

There are several complications that can occur because of hyperacusis. Complications include:

• Anxiety
• Depression
• Social isolation
• Loneliness
• Avoidance
• Relationship issues
• Sleep disturbance
• Decline in physical health