Hyperacusis is the intolerance to normal ordinary environmental sound. The specific sound usually does not provoke any discomfort in the majority of people. It may present with emotional, social and physical problems. Patients can become very anxious, depressed, isolated, and develop avoidance behavior to certain conditions. Patients also experience physical pain and discomfort in the ear. Hyperacusis is often accompanied by tinnitus.
The true prevalence is not known. It is estimated to range from 5,9% – 17,2 % depending whether patients with hearing loss are excluded. Even in small children it is sometimes observed that certain sounds may be irritating, often having the child grabbing their ears. Adolescents are sometimes labeled as being emotional and that the hyperacusis they complain about is mere a psychological problem.
Although intolerance to loud sound occurs with certain types of hearing loss (loudness recruitment) hyperacusis can occur in patients with normal hearing. Some patients may even feel that they can hear better than most other people. This phenomenon is well known to occur in patients with superior canal dehiscence (SCD) where an abnormal opening in the bone of the inner ear of these patients exists. To make things worse in patients with SCD, it can be accompanied by the Tulio phenomenon. The Tullio phenomenon occurs if a patient becomes dizzy when exposed to certain loud sounds.
Phononphobia is the fear and often avoidance of loud sound during certain periods. It often occurs during a migraine attack but is usually not present all the time. The avoidance or fear of the sound produced by your wife’s mouth on a Saturday afternoon that you should wash the car and mow the lawn when you actually just want to sit down and watch the rugby is not phonophobia or hyperacusis for that matter. It is normal!
The true mechanism whereby it occurs is not known. Scientific experiments demonstrate that the main problem is unlikely in the inner ear but rather in the central auditory pathways for sound in the brain.
Hyperacusis is managed by the avoidance of provocative noise, cognitive behavioral therapy, noise protection. Tinnitus retraining therapy (TRT), hearing amplification devices, and gradual sound exposure are other options. A surgical procedure has lately emerged as an alternative treatment option for hyperacusis.
