by Neil Bauman, Ph.D.
© November, 2020
Being hypersensitive to sound is not particularly high on my list of enjoyable activities to put it mildly! When you are hypersensitive to sounds, you discover to your consternation that certain sounds, many sounds or all sounds are so loud that they make you wince, jump, cry out with pain or even lose your balance. Yet the truth is, these sounds are often normal, everyday sounds that are not even particularly loud. As a result, you may become annoyed, angry or fearful of sounds, find it difficult to live in our noisy world and thus ultimately withdraw from society.
You may seek help from professionals whom you think should be able to assist you, but as so often happens, the doctors you consult know even less that you do about your condition. Unfortunately, the truth is, few doctors know much, if anything about the various hypersensitivities to sound that we have to endure. As the founder of the Hyperacusis Network once lamented, “Ear Nose and Throat doctors (ENTs) are renowned for misdiagnosing our condition [hyperacusis], giving poor advice and/or subjecting our ears to tests which collapse our tolerance to sound even more.”
Even fewer doctors know how to effectively treat these conditions. There is little good information on the subject. Therefore, you typically have to take charge and learn what is safe for your ears on your own. Unfortunately, when you have hyperacusis, you instinctively choose what seems to be the logical treatment—wear ear protectors to protect your ears from the painfully-loud sounds you now hear. Unfortunately, this coping strategy is often exactly the opposite of what you should be doing. Over-protecting your ears just makes your hyperacusis progressively worse, not better.
Since these wrong or inappropriate treatments leave you worse off than you were before, you sink into deep depression. You think you’ve just been given a life sentence with no hope of parole on the horizon.
Many people with hyperacusis are desperate for help. At this point what you need more than anything else is hope, and along with hope, a plan to successfully get your sensitivity to sound back to normal. Hyperacusis may seem to be a rare condition, but in reality, people with hyperacusis inundate me with their pleas for help. Seldom a day passes without someone contacting me for help.
Since there is so little good information readily available on the various kinds of sound hypersensitivities, I have spent the past four years researching this subject. I have distilled what I have learned into a comprehensive book entitled, Hypersensitive to Sound? Successfully Deal with Your Hyperacusis, Recruitment & Other Sound Sensitivities that was just released this month (November, 2020). This book teaches you what the various sound hypersensitivities are and what you can do to free yourself from these strange conditions and get yourself on the road to recovery.
There are a number of different hypersensitivities to sound. If you are hard of hearing you have probably heard about/experienced recruitment. That is one kind of sound sensitivity. You may even have heard the term “hyperacusis” and know it has something to do with perceiving sounds as much too loud.
However, you probably don’t realize that hyperacusis is not just one condition, but is actually a whole family of disorders lumped together under the umbrella of “hyperacusis”. What you likely don’t know, and really need to know, is that each of the various “kinds” of hyperacusis have their own specific treatments. Using the wrong treatment just makes things worse. Thus, you need to have an accurate diagnosis of you specific kind of hyperacusis before trying to treat it.
Furthermore, you may find that you may have just one kind of hyperacusis, or more likely, you may have two or more kinds at once—for example, you may have a combination of loudness hyperacusis and pain hyperacusis at the same time (a fairly-common combination)—yet each kind needs its own specific treatment.
Not only does each condition need its own treatment, but when you have more than one condition, each one needs to be treated in the correct order depending on which conditions you have. Using the correct treatments, but treating them in the wrong order, or treating them all concurrently can be a recipe for disaster as numbers of people have found out to their sorrow.
Just teasing apart the various disorders can be a challenge in itself. Making matters even worse, other conditions that can have similar symptoms such as Tonic Tensor Tympani Syndrome (TTTS), Stapedial Myoclonus, Acoustic Shock disorder (ASD), Superior Canal Dehiscence Syndrome (SCDS), Third Window Syndrome (TWS) and so on are often intertwined with them.
To help you figure out what sound sensitivity disorders you may have, I have briefly outlined below the 10 conditions that are often lumped (in whole or in part) under the single term “hyperacusis”.
1. Loudness Recruitment
Loudness recruitment is often just referred to as “recruitment”. It is a byproduct of having a sensorineural (inner ear) hearing loss. If you have a sensorineural hearing loss, you will have recruitment to some degree or other whether you realize it or not. Recruitment results in an abnormally-rapid growth of perceived loudness for those sounds located in the pitch region of your hearing loss.
Here is an example of recruitment kicking in. You are talking with a person and you can’t quite hear them so you ask him to speak up a bit. He complies with your request, and raises his voice slightly. However, to you it now sounds like he is shouting at you. You retort, “You don’t have to yell at me! I’m not deaf!” If this is your kind of experience with sound, you have loudness recruitment. As one person succinctly put it, “With recruitment, your auditory system goes from too little to too much too fast!”
2. Loudness Hyperacusis
Loudness hyperacusis is where you have a lowered tolerance to sound such that you can’t stand sounds as loud as you used to be able to. This is typically the kind of hyperacusis people really mean when they say they have hyperacusis.
When you have loudness hyperacusis, you perceive some or all normal sounds as being too loud, much too loud or even painfully loud. For example, if you have severe loudness hyperacusis, a car whizzing down the road past you may sound to you like a jet plane screaming past you at take off.
Typically, you get loudness hyperacusis when you expose your ears to excessively loud sounds—it could have been a loud concert, a sports event, a gunshot or any sudden, loud sound. After the event, you notice that sounds now seem muffled, and your ears ring (tinnitus). A few days later, you realize that your ears are becoming more and more sensitive to sounds. This is how loudness hyperacusis often begins. You can also get loudness hyperacusis from taking any one of a number of ototoxic drugs that have this nasty side effect.
3. Reactive Tinnitus
Reactive tinnitus occurs when you have both tinnitus and loudness hyperacusis (although you may not even realize you have hyperacusis and just think you have a weird kind of tinnitus), and your tinnitus interacts with your loudness hyperacusis such that when you hear (louder) sounds, your tinnitus also gets louder. Now you have two nasty conditions to deal with instead of just one.
Note that trying to treat the tinnitus component or reactive tinnitus without first treating the loudness hyperacusis component just makes things worse.
4. Amplification (Hearing Aid) Hyperacusis
Amplification hyperacusis (hearing aid hyperacusis) occurs when your hearing aids (or other assistive listening devices) are not programmed correctly for your specific hearing loss and fail to accommodate any sound sensitivities you may have. Thus your hearing aids over-amplify certain frequencies of sounds such that they shoot through the ceiling of your dynamic range at that frequency.
Whenever this occurs, you perceive these particular sounds as being so loud that they hurt and you wince, jump or rip your hearing aids out of your ears. However, when you are not wearing your hearing aids, those same sounds do not bother you.
Therefore, if you are wearing hearing aids, and clinking cutlery or a glass being set on a hard surface, or a door slamming causes you to wince or “blows the top of your head off” because it sounds so loud and “sharp” to you, but not to those around you, you are experiencing amplification hyperacusis.
5. Annoyance Hyperacusis
Annoyance hyperacusis (also known as misophonia), is where you have developed a conditioned reflex—an abnormal negative emotional reaction—to specific sounds (called trigger sounds). Whenever you hear even a single occurrence of these trigger sounds, this conditioned reflex instantly and automatically jerks a strong, irrational emotional reaction out of you.
For example, you may rage at your spouse or a parent for smacking his lips, yet he is eating quietly—but that’s not how you perceive that horrible sound.
Therefore, if certain sounds a given person makes instantly make you annoyed, disgusted or angry at them—even though these sounds are relatively soft, you are experiencing annoyance hyperacusis (misophonia).
6. Fear Hyperacusis
Fear hyperacusis (also known as phonophobia), is where you have developed a phobia to some or all sounds such that whenever you hear those sounds, they fill you with fear or terror. You are literally afraid of those sounds because of what they do to you emotionally. For example, you may be afraid to go to work or go into the noisy cafeteria or be around loud sounds. Even the thought of being around such sounds may terrify you. This fear of sound may cause you to avoid social situations.
Fear hyperacusis can grow out of untreated loudness hyperacusis or pain hyperacusis.
7. Pain Hyperacusis
Pain hyperacusis, is exactly what it sounds like. You feel pain when you hear certain/all sounds. If you have pain hyperacusis, certain sounds at modest intensities can cause you to feel pain or cause painful headaches and migraines. For example, when some people hear what to them is a louder sound, it feels like someone has just stabbed them in their ears, or shoved a red-hot poker in their ear canals. These pain sensations occur at much lower sound levels than would typically prompt pain.
Pain hyperacusis is itself comprised of a number of somewhat-related conditions that cause pain, all collected under the umbrella term of pain hyperacusis. These conditions include disorders such as Tonic Tensor Tympani Syndrome (TTTS), Acoustic Shock Disorder (ASD), Eustachian Tube Dysfunction and Stapedial Reflex Dysfunction (stapedius myoclonus).
Sometimes two or more of these conditions are intertwined and thus may occur together. For example, if your voice sounds both loud and muffled, and you experience pain in your ear(s), you may have tonic tensor tympani syndrome (TTTS) or Acoustic Shock Disorder or both.
8. Vestibular Hyperacusis
Vestibular hyperacusis is where (louder) sounds cause balance problems such as dizziness or vertigo. In extreme cases when you hear a sudden, loud sound, you may drop to the ground as if you had been poleaxed.
When you have vestibular hyperacusis, your cochlea has a “third window” in addition to the normal oval and round windows. This third window lets auditory signals sneak into the vestibular areas of your inner ear where your brain interprets them as (spurious) balance signals that mess up your balance.
There are a number of third window conditions. The most common of these is Superior Canal Dehiscence Syndrome (SCDS), often called Tullio’s phenomenon.
9. Conductive Hyperacusis
Conductive hyperacusis, technically conductive hyperacute hearing, is not the typical kind of hyperacusis due to a decreased tolerance to sound. Rather, conductive hyperacusis is a form of “true” hyperacusis—where, due to various middle and inner ear conditions, you actually hear various body-generated sounds/functions amplified via bone conduction. The result is that you hear these body sounds louder than normal. This can be very annoying.
In some cases, conductive hyperacusis can be totally weird because your audiogram shows you have an air-bone gap indicating that you have a conductive hearing loss, but you don’t. You actually have a conductive gain (pseudo-conductive hearing loss). That’s enough to make any audiologist scratch his head.
If your voice sounds abnormally loud to you, or if your breath is a loud whooshing sound, or chewing your food sounds more like thunder than chewing food, or you hear your joints creaking or your vertebrae clicking or your eyeballs moving, then you have conductive hyperacusis.
Two conditions that fall under the conductive hyperacusis umbrella include patulous Eustachian tubes and otosclerosis.
10. Sensorineural Hyperacute Hearing
Sensorineural hyperacute hearing is where your hearing (particularly in the very high frequencies) is naturally so sensitive that you can hear softer sounds than can people with normal (“perfect”) hearing. Two groups of people that often experience hyperacute hearing include those with extreme reverse slope hearing losses and those with autism.
For example, if you have extreme reverse slope hearing loss, you can hear sounds at levels too soft for most people with normal hearing to hear, yet at the same time, you are functionally deaf in the speech frequencies. That is hyperacute hearing in action.
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In this book, there are chapters (or two or more chapters) on each of these various kinds of hypersensitive hearing conditions. Not only will you learn what each kind of hypersensitivity is and what causes it, but even more importantly to you, you’ll learn the latest strategies for successfully dealing with them.
If your ears are hypersensitive to sound, you don’t have to let these sound sensitivities control your life. Don’t lose hope. In some cases, medical interventions can largely fix your problems. However, in many cases, it is up to you to take control, and though hard work—guided by knowledgeable professionals—get your ears (and your life) back on track again.
You can get the book Hypersensitive to Sound? (printed or eBook format) from the Center’s website.