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 originate 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 fatigue.  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. 

What is retraining therapy?

Retraining therapy (TRT) uses broadband sound to re-establish a patients tolerances to sound.  Broadband sound is a broad brush which covers many colors of sound.  White broadband sound is the culmination of all sound frequencies.  White sound however contains equal energy in all frequencies including the higher frequencies.  The hyperacusis patient is highly sensitive to the higher frequencies like those above 8,000 Hertz.  To speed the recovery of a hyperacusis patient it is important for the patient to have a hearing diet of very soft sound which does not include the high frequencies.  The answer to this is called pink sound.  If the patient softly listens to pink sound for a disciplined period of time each day they usually find that their tolerances improve and they can return to the mainstream of life.  There are two delivery systems for pink sound.  One is through wearing a special hearing aid called a sound generator.  It looks like a hearing aid which is designed to delivery broadband pink sound into the ear.  The other delivery system is by playing a pink sound CD which is available through this network.

I am about to have an MRI. What can I do to protect my ears from the loud sound of this procedure?

First of all, you need to practice putting foam earplugs in correctly. Most people are clueless on how to do that. If you do it properly you will have a hard time hearing people talk to you. After you put the foam earplugs in correctly, the clinician normally has earmuffs for you to wear on top of that. You can check ahead to see if they have earmuffs. If not, you can purchase earmuffs but they cannot contain any metal in them.

Can the sound of a dentist’s drill cause or worsen tinnitus or hyperacusis?

Jack Vernon, Ph.D. wrote, “There is no doubt that dental drilling can exacerbate tinnitus (or hyperacusis) in some patients, and I’d much rather be cautious than sorry.  For dental drilling, I always recommend 5 seconds of drilling then 10 seconds off – 5 on, 10 off – until the job is finished.  The sound is directly conducted to the inner ear by bone conduction, and wearing ear protection will only serve a partial purpose.  Some dentists charge extra for the “5 on/10 off” approach, but most willingly cooperate.  The impact that noise has on hearing is controlled by two elements: the intensity of the sound (how loud it is) and the duration of the sound.  We cannot control the intensity for the dental drill, but we can control the duration of the exposure.  Vernon and Sanders: Tinnitus – Questions and Answers, 2001, pp. 61-63

My ears are sensitive to all sounds, my internist put me on an antihistamine and said it will probably go away in a few weeks.  It hasn’t gone away and now my internist says I should give it more time.  If it doesn’t improve he says I will just have to learn to live with it.  What should I do?

It is am amazed at how loyal patients are to their doctors when they offer no options or don’t have the where-with-all to look into the problem and help their patient.  We applaud doctors who contact the network and ask for any information they can offer to their patient because they know little to nothing about hyperacusis.  The first thing you should do is find a clinician who specializes in treating hyperacusis. Visit this link: http://www.tinnitus-pjj.com/referral.html  It is likely you will have to travel to find a specialist but to do anything else is wasting your time and your money.  The sooner you seek help the sooner you will improve your tolerances to sound.

Rather than go through retraining therapy (TRT) I think I will just try bucking it out on my own and be careful when I am exposed to any loud noise. Is there anything wrong with that approach?

If you have hyperacusis and your life has been significantly impact by the noise of your everyday surroundings then you have two options.  Your way may improve your sensitivity to sound but the progress will be very slow.  Without the proper counseling from a qualified clinician you will have no way to track your progress and get answers to the many questions that all individuals have who are living a life with hyperacusis (overprotecting, phonophobia, ear pain, etc.).  The other option is to embark on a focused treatment that will help you recover in a timely manner so you can get on with your life and not evaluate every single thing you do in terms of how much noise it is going to generate. 

I don’t know if noise is the reason I got myself in this predicament but I can’t imagine using noise to get me out of it.  I don’t like the idea of listening to noise. At this point I want total quiet! 

Anyone with severe hyperacusis can relate to those feelings.  Sometimes we waste an awful lot of time trying to figure out how we got hyperacusis.  This can be a waste of time and postpone our recovery.  Our survival instinct is strong when we have been injured.  In the case of hyperacusis everything inside of us tells us to isolate ourselves from noise.  All clinicians would discourage you from doing that.  I know that when I first came down with severe hyperacusis, at the end of the work day my ears were so worn out being in the company of people that I could not even tolerate the sound of my children whispering.  At that point I was hearing at minus decibel levels.  Yes, my ears did need a rest but only for a short time before I needed to embark on the proper treatment.  You need a qualified clinician.  They will rule out any physical problems which could have made your ears more sensitive.  They will, ever so gently, test your sound tolerances to determine the degree of your sensitivity.  They will explain what has happened to your ears.  After all, we all want to know what really happened here!  They will prescribe a sound therapy for you that is ever so gentle.  It will not only improve your tolerances to sound but make your ears less vulnerable to any setbacks.

I am more than willing to make an appointment with a qualified clinician but travel is very difficult for me right now.  My children all live out of town. I told them if they want to see me they have to come here so I don’t have to ride in a car for any amount of time. I can’t imagine flying in an airplane and driving in a car to see a qualified clinician. What am I supposed to do? 

I have just started Tinnitus Retraining Therapy and find that some days my ears feel more sensitive than others.  Is this normal? 

My family thinks I am making this whole thing up.  I feel like I have nowhere to turn.  Someone in my family even suggested I go see a shrink.

There is no qualified clinician in our state. I am living on welfare and cannot afford the travel or expense of TRT. What am I to do? 

How do I clean the wax out of my ears? My tinnitus seems worse and I think it is because my ears have too much wax in them. My doctor wants to irrigate them but I read once that this can make things worse.

What is the success rate for Tinnitus Retraining Therapy?

Why do my ears feel like there is pressure on the eardrum? 

I don’t know if I have hyperacusis or recruitment. What is the difference? 

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