What is Hyperacusis?

Imagine being at a movie where the soundtrack 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 cannot 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 motorboat 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 accommodate 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 because 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.

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