Category 1

Hyperacusis has little impact on the patients life.  Sounds reaching 80-85+ decibels require ear protection only because the patient feels they have sensitive hearing or it could damage their hearing.  This patient may also feel inclined to protect their ears in loud environments because tinnitus (ringing in the ears) is noticeable after prolonged sound exposure.  The patient may also feel some degree of fatigue after prolonged sound exposure or feel a slight pressure or feeling of fullness in their ears when sounds are near or above 85 decibels.

Category 2

Hyperacusis moderately impacts the patients life.  Sounds at 65+ decibels (talking/normal conversation) are perceived as loud.  The noise of mainstream living is challenging.  The patient seeks controlled sound environments and starts interpreting all daily events in terms of the noise that might potentially be produced.  Misophonia (dislike of noise) may become a problem or phonophobia (fear of noise).  A feeling of fullness in the ears and/or burning at times is felt by the patient.  It is critical that the patient seek help from a qualified hearing clinician who administers sound retraining therapy (TRT - Tinnitus Retraining Therapy).  A patient's Loudness Discomfort Levels (LDL's) are established by the clinician and a protocol is prescribed to re-establish the patients sound tolerances.

Category 3

Hyperacusis is a significant problem.  Sounds at 50+ decibels (background noise/soft music) are perceived as too loud.  Mainstream living is very difficult and normal conversation is too loud.  The patient seeks isolation not only dealing with their collapsed tolerance to sound and is very susceptible to phonophobia (fear of noise).  The patient seeks controlled sound environments and interprets all daily events in terms of the noise that might potentially be produced.  The patient has a tendency to wear ear protection too much which will tend to make their ears even more sound sensitive.  A feeling of fullness in the ears and/or burning is very pronounced.  By the end of the day they are exhausted from the sound they have endured trying to survive in their normal daily routine.  It is critical that the patient seek help from a qualified hearing clinician who administers sound retraining therapy (TRT - Tinnitus Retraining Therapy).  A patient's Loudness Discomfort Levels (LDL's) needs to be established by the clinician and a protocol prescribed to re-establish the patients sound tolerances.  Anxiety, lack of sleep, pain in the ears are common and must be treated in addition to sound retraining therapy (TRT) for the patient to recover.  Some patients need some short term help to sleep through the use of medication.

Category 4

Hyperacusis is at a crisis level.  Sounds below or significantly below 50 decibels (whispering) are perceived as too loud.  Mainstream living is not possible.  The patient is isolated and barely able to communicate because they cannot even tolerate the sound of their own voice.   Talking to others, speaking on the telephone, listening to television, running water, even the sound of wind outside is overwhelming for the patient.  If catagory 4 severe hyperacusis comes on suddenly the patient's world is turned upside down.  It is difficult for them to even live in the company of their family (particularly if there are small children).  Women's voices are frequently difficult to tolerate because the tone of their voice is a higher frequency than mens. Some patients this severe may be able to produce audiograms proving they can hear at minus decibel levels.  Anxiety, lack of sleep, depression, strong ear pain, and phonophobia are common problems due to severely collapsed tolerances to sound.  Special considerations (over and above sound therapy) are needed to help this patient in crisis so they can slowly regain their tolerances to sound.  Anxiety and sleep deprivation must be aggressively treated by the clinician so the patient can be motivated to start sound retraining therapy.  Although medication is generally discouraged for hyperacusis patients it may be absolutely necessary on a short term basis to allow the patient to finally rest at night, reduce their anxiety level of dealing with the onslaught of all sounds being on a daily basis and see that there is light at the end of the tunnel.  This is critical for this patient in crisis.