A wise man once said, “most people like to give simple answers to complex questions.” When applying this philosophy to treating hyperacusis, the simple answer is “yes.” However, this answer is not without its own complexities. There are several causes for hyperacusis, and successful treatment depends on many factors.
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What Is Hyperacusis?
Understanding what hyperacusis is and the various etiologies of its development are critical to answering the questions of if and how medical professionals can treat this condition. The root word of hyperacusis is from hyper, indicating beyond, super, or excessive, and the ancient greek word for “hearing,” ἄκουσις (ákousis). Consequently, hyperacusis is a disorder of sound volume perception.
Patients with hyperacusis experience the condition in different ways. The sufferer generally perceives regular volume sounds as painfully loud and often distorted. Audiologists identify four types of hyperacusis, which often overlap:
- Fear or anxiety
What Causes Hyperacusis?
Unfortunately, there isn’t an identifiable physiologic mechanism that science has identified that causes hyperacusis. It is known, however, to develop alongside other conditions, considered risk factors. The most common risk factor of hyperacusis is paradoxical. Hyperacusis is frequently a consequence of age-related hearing loss (presbycusis) or hearing loss from repeated exposure to loud noise. It can occur unilaterally (one ear) or bilaterally (both ears).
The accentuated perception of sound in hyperacusis is typically associated with tinnitus. Patients describe tinnitus as a “ringing in the ears.” It is the perception of sounds that originate from within the body, not externally. The “ringing” can be a buzzing sound, humming, or grinding sensation. Tinnitus is a presenting complaint in Meniere’s Disease, a disorder of the inner ear that produces vertigo. Hyperacusis can also be a result of the condition.
Hyperacusis has been linked to many conditions including:
- Frequent middle ear infections
- Middle ear damage
- Head trauma
- Autoimmune diseases
- Bell’s Palsy
- Lyme Disease
- TMJ disorders
- Ramsay Hunt Syndrome (facial Herpes Zoster [shingles])
Interestingly, hyperacusis is more common in Down’s Syndrome and Autism. However, the causation is not understood. In addition, individuals with depression and anxiety disorders are affected more often.
Is There a Cure for Hyperacusis?
Unfortunately, there is no cure for hyperacusis. However, treating an associated underlying medical condition may resolve or improve the disorder. For example, prompt initiation of antiviral therapy for Herpes Zoster (shingles) of the facial nerve (Ramsay Hunt Syndrome) can mitigate or prevent hyperacusis. In addition, wearing a mouth guard to avoid nocturnal grinding with temporomandibular joint (TMJ) syndrome may improve symptoms.
Conventional therapy for hyperacusis often employs cognitive therapy. Specialists design a two-step approach for retraining sound perception to reduce the mental reaction to loud sounds. The combination of acoustic therapy and counseling has helped many cope with this often painful, and always disconcerting condition.
Acoustic or sound therapy is a desensitization treatment. The idea is to retrain the brain to accept the sound less painfully. Typically the patient wears a device that generates noise for at least two hours daily.
As the patient accommodates the volume level, it slowly increases. In theory, this reprograms the auditory processing center in the brain. In combination with counseling, acoustic therapy has been beneficial in many cases.
Counseling concurrently with acoustic therapy supports the continuation of acoustic therapy and helps patients minimize the fear of sound. Patients who find normal conversational tones painful tend to isolate. Isolation then produces another set of emotional dysfunctions that further complicates the primary condition.
One problem with using acoustic therapy combined with counseling is that there needs to be controlled studies to judge efficacy. Without knowing how many people fail this approach due to setbacks and lacking a placebo group, it is impossible to demonstrate success. However, anecdotal reports from patients indicate it works in some cases.
Another caveat is that the professionals who provide the treatments often perform combination therapy studies, possibly forming an apparent conflict of interest.
One supposition about the physiologic cause of hyperacusis is that it is a nerve pathway or nerve damage issue. After all, the acoustic nerve is how humans conduct hearing. Even though some professionals detect no nerve damage or signs of inflammation on diagnostic scans, they intuitively implicate the nervous system.
Medical practitioners use several anticonvulsant (anti-seizure) medications commonly used for neuropathies (nerve pain). A typical example is the drug gabapentin. Drug companies developed gabapentin for seizure control in people with epilepsy. However, it is a first-line off-label drug to relieve the pain of postherpetic neuralgia (pain following shingles) and lumbar radiculopathy (“pinched nerve” in the lower back).
Another adjunctive therapy to minimize the discomfort of hyperacusis is wearing a headset with continuous white noise at a very low volume. In physics, the term white noise is defined as “noise containing many frequencies with equal intensities.” In common usage, it refers to constant background sounds. Patients typically use white noise to drown out or mute incoming sounds.
The use of white noise in hyperacusis is more of a “band-aid” rather than a therapy. Again, many patients find life more tolerable using this modality. However, some patients find that even white noise is intolerable. In those cases, some of them have found relief in earplugs.
If all else fails, holistic treatments are also a viable option for minimizing the effects of hyperacusis. A full service chiropractor can help patients find relief by restoring their upper cervical spine’s natural alignment. Chiropractors often perform adjustments to the upper spine and neck, reducing the pressure on the nerves running through your neck and inner ear.
Conditions such as temporomandibular joint disorder (TMJ) create tension in the jaw and can put stress on the nerves and ligaments around the ears. Getting an adjustment can help with treating TMJ along with a variety of other issues such as bodily tension and poor posture that may also affect the way your body processes audio.
No Easy Answer
There is no doubt that hyperacusis deserves more time and research for those who suffer. The exact incidence of hyperacusis in the population is unknown, but estimated to be between 0.2% and 17.2%. This wide range is further evidence that researchers have much more work to do to understand the condition.
In addition, many healthcare professionals typically do not have a basic understanding of the disease process. As a result, patients are frequently labeled as “overreactive” and referred to psychiatry services. Hopefully, continued research will provide new treatments for hyperacusis.