What Is Hyperacusis?
Hearing Everyday Sounds as Abnormally Loud
Medically reviewed by John Carew, MD
Hyperacusis is a problem that causes ordinary sounds to be sensed as abnormally loud. Even everyday sounds, like washing your hands or listening to the radio, may be painfully loud. If you have hyperacusis, you may have sensitivity to sounds that others find normal. You may find regular sounds to be painful, frightening, or unpleasant.
The development of hyperacusis is not well understood. It can affect both children and adults. This article will review the symptoms, common causes, and treatments for hyperacusis.
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Symptoms of Hyperacusis
Hyperacusis is a sensitivity to sound levels that the general population can more easily tolerate. Some such sounds include:
Conversation
Running water
Mechanical sounds from a washer, dryer, or dishwasher
Radio, TV, or background music
Motor vehicle engines
Four types of hyperacusis define the effect of sounds on a person. These are categorized as loudness, annoyance, fear, and pain. It is common for sounds to have elements of one or all categories in combination. Some sounds may be annoying, while others may trigger physical pain.
Among the general population, sound levels become obnoxious and painful at around 100 decibels (dB). However, for someone with hyperacusis, the level at which sound is obnoxious or painful can be reduced to as low as 16 to 18 dB.
For reference, a normal conversation measures around 60 dB, and a refrigerator hum measures approximately 40 dB. Consequently, for those with hyperacusis, most activities can trigger symptoms and often extreme sensitivity to sound.
Many people with hyperacusis also have tinnitus, which is a condition of phantom sounds in the ear, such as ringing. Hyperacusis can place a significant burden on your quality of life and impact your well-being, concentration, and sleep.
Signs and Symptoms in Children
It can be difficult to detect how your hearing, or your child's, is different from the hearing of others without testing. An estimated 3% of children and adolescents experience some form of hyperacusis.
Hyperacusis is often mischaracterized, particularly in young children who have difficulty explaining what is happening. Signs of hyperacusis can include irritability, difficulty concentrating and staying focused, and even acting out against others.
Hhyperacusis and sensitivity to noises are among the symptoms of autism spectrum disorder. Specific places or sounds may be particularly bothersome and trigger symptoms without a clear pretext. Consider a hearing evaluation if your child avoids certain places, sounds, or activities.
Paying attention to your child's behavior and symptoms can help you identify hyperacusis as early as possible. Because hearing is different for everyone, you may notice signs or problems in your child that others do not.
Causes
Hyperacusis can occur in children and adults. It is not always permanent, and it can develop at any time.
Hyperacusis may develop after certain injuries and illnesses:
Head trauma
Exposure to loud noise: This can be a onetime event (such as an explosion or gunshot) or long-term unprotected exposure to loud noise (such as noisy machinery or music).
Viral inner-ear infections
Surgery on the jaw or face
Conditions linked to hyperacusis include:
Bell's palsy (inflammation of the facial nerve leading to partial or complete facial weakness)
Lyme disease (a bacterial infection spread by ticks)
Meniere's disease (an inner ear disorder)
Migraine (a chronic headache disorder)
The exact causes of hyperacusis are not well understood. Some theories suggest that hyperacusis is triggered in the brain in the region where the brain interacts with the auditory system. Certain pain-signaling pathways, such as NTRK1 signaling, may also be involved in the sensitivity to sound.
Other theories suggest hyperacusis is caused by abnormal development of the structures that make up the auditory system (ear canal, tympanic membrane, stapes, and cochlea). Because hyperacusis can vary from person to person, it likely involves several different components.
In some cases, paralysis or disruption of the facial nerve can lead to the development of hyperacusis. Hyperacusis can develop after an inflammatory disorder impacts the facial nerve, such as Bell's palsy, or an infection, such as shingles (herpes zoster) or Lyme disease.
These conditions can affect the facial nerve, which connects the brain to the auditory system. If the inflammation is severe, this can lead to sensitivity to sound that develops into hyperacusis. Often, this form of hyperacusis self-resolves over time.
Hyperacusis is complex. No gene by itself or group of genes has been concretely linked to the disorder. Certain genetic syndromes, such as Williams syndrome, increase the risk of developing hyperacusis.
Diagnosis and Testing
A healthcare provider may recommend a hearing test with an audiologist (a specialist in hearing disorders) to determine your sound tolerance.
The definitive test for diagnosing hyperacusis is a hearing test (audiometric test). An audiologist performs this specialized testing to help determine how someone perceives sound.
The testing comprises a series of sounds played through speakers and earphones. Different sounds are presented at different volume intensities, and you are asked to respond to each sound.
After the testing, the audiologist creates a report on your hearing, which you can review with a healthcare provider. The testing for hyperacusis shows sensitivity to low-volume sounds.
Treatment for Hyperacusis
Treatment for hyperacusis is at first supportive. People often use noise-reduction strategies like wearing earplugs, earmuffs, and other sound-dampening devices. Tools like noise-canceling headphones may also help reduce unwanted noise.
However, experts warn that sound avoidance gives only temporary relief. When people with hyperacusis remove noise-reducing devices or leave a quiet area, sounds can seem even louder than before.
Instead, gradually exposing yourself to progressively louder sounds builds sound tolerance and reduces sensitivity.
Sound therapy is a treatment undergoing study for hyperacusis and may apply to clinical situations. It uses a device to produce barely audible white noise (like static) in the ear. The goal is to retrain the brain's sound processing center to tolerate sound better. A person may need to wear the device for a year.
Cognitive behavioral therapy is also used to help people change how they think about their symptoms. It can also help reduce anxiety related to the condition.
No specific surgery has been shown to correct hyperacusis. However, this remains an area of research.
Hyperacusis symptoms can change over time. Though the sensation of hyperacusis may never completely resolve, your treatment and management strategies may provide some relief.
Multidisciplinary Health Teams
The treatment of hyperacusis involves healthcare providers such as doctors and specialists from several disciplines. Otolaryngologists, (doctors with training in ear, nose, and throat disorders), also called ENTs, and neurologists (specialists in conditions affecting the nervous system) are usually involved in treating hyperacusis.
Audiologists who perform hearing tests and assessments frequently work with ENTs and neurologists to help diagnose hyperacusis. Because hyperacusis is often accompanied by significant anxiety and stress around sounds, psychologists and psychiatrists may participate in care, as well.
These specialists can collaborate to provide coordinated and specific treatment plans for your care.
Summary
Hyperacusis is oversensitivity to sounds that do not cause problems for most people. It can develop in children or adults and may be temporary or permanent. Signs in children include irritability and avoiding certain places and situations.
Causes include exposure to loud noise, head injury, migraine, infections, and conditions present at birth, such as autism spectrum disorder. A hearing test can determine whether a person has hyperacusis. Treatment includes methods to desensitize to sound and change how a person thinks about the condition.
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