Questions and Answers

What is hyperacusis?

Hyperacusis (Hyper-a-CU-sis) is a collapsed tolerance to normal environmental sound.  All sounds are perceived as too loud.  Also quick shifts in sound are difficult for the patient to tolerate. 

Hyperacusis can occur in one or both ears.  It can occur suddenly or over a period of time.  It can be accompanied with or without hearing loss.  If the hearing loss is significant the condition is called recruitment.  If the hearing loss is minimal, typically it is referred to as hyperacusis.

Hyperacusis can also be accompanied by tinnitus (Tin-EYE-tus).  Tinnitus is the perception of sound in the head when no outside sound is present.  It is typically referred to as ringing in the ears but others may describe the sound as hissing, roaring, pulsing, whooshing, chirping, whistling or clicking have been described.

Is hyperacusis a common problem?

No.  Hyperacusis is rare.  The most common reaction to a noise injury is hearing loss and/or tinnitus.  It has been commonly reported that 50 million people have tinnitus.  A common report from the American Tinnitus Association (www.ata.org) has revealed that approximately 40% of tinnitus patients have some difficulty with hyperacusis.  Actually 40% of tinnitus patients have sensitivity to sound but this is NOT hyperacusis.  It is only when the patient has significant, pronounced sensitivity to sound where their loudness discomfort levels (LDLs) so collapsed that they impact their lives on a daily basis.  True hyperacusis is so rare that most hearing doctors do not know of the condition and often subject the patient to hearing tests which further collapse the patients tolerance to sound.  It is for this reason that a doctor must establish the patients LDLs before any hearing tests are administered.

Is hyperacusis a disease?

No.  Just as a fever or headache accompanies many different illnesses, hyperacusis is a symptom.  Although many times people complain of being sensitive to sound for a short period of time following a loud rock concert or while they have a  migraine headache, this is not hyperacusis.  Hyperacusis a symptom where the patients tolerance to sound does not improve.  The most common cause is from a significant noise injury.  Other causes of hyperacusis can come from Lyme disease, Bells Palsy, TMJ, drugs which are not ear friendly, irrigating (cleaning) the ears, Williams Syndrome, Meneires Disease, and just a host of other illnesses.

What causes hyperacusis?

There is speculation that the efferent portion of the auditory nerve has been affected (efferent meaning fibers that orginate in the brain which serve to regulate sounds).  Others feel hyperacusis is a brain processing problem specific to how the brain perceives sound.  Others feel it is a combination of both. 

Why is my hyperacusis often worse when I wake up and before I go to bed?

Individuals with hyperacusis have ears that yearn for total silence.  Night time is quiet time.  After a full night of total quiet, it is often hard for the hyperacusis patient to face the noise of a new day.  Some hyperacusis patients even wear ear protection at night and it even becomes more difficult to face the noise of a new day.  This is just one example of why the patient is being given a wrong directive from their survival instinct and living in total silence is the wrong approach. 

Hyperacusis patients also experience sound fatique.  At the end of a day their ears are tired and less tolerant of noise.  Almost all hyperacusis patients experience a symptom commonly referred to as fullness in the ears.  It is a feeling where the patient feels pressure in the ear or the sensation that someone is actually pressing on their eardrum.  Other patients feel pain or burning in the ears.  From time to time doctors will tell the patient that the ears are incapable of experiencing pain.  This is not true.

What should I do about my hyperacusis?

You should have a medical examination by someone who is knowledgeable about hyperacusis.  There are very few doctors in the world that understand hyperacusis.  As a starting point you can visit the website for the Tinnitus Retraining Therapy Association (http://www.tinnitus-pjj.com/referral.html).   Individuals listed here also administer a retraining therapy which is similar to tinnitus retraining but is customized for the hyperacusis patient so they can re-establish their tolerances to sound. 

What is retraining therapy?

Retraining therapy (TRT) uses broadband sound to re-establish a patients tolerances to sound.  Broadband sound is a broad brush which covers many colors of sound.  White broadband sound is the culmination of all sound frequencies.  White sound however contains equal energy in all frequencies including the higher frequencies.  The hyperacusis patient is highly sensitive to the higher frequencies like those above 8,000 Hertz.  To speed the recovery of a hyperacusis patient it is important for the patient to have a hearing diet of very soft sound which does not include the high frequencies.  The answer to this is called pink sound.  If the patient softly listens to pink sound for a disciplined period of time each day they usually find that their tolerances improve and they can return to the mainstream of life.  There are two delivery systems for pink sound.  One is through wearing a special hearing aid called a sound generator.  It looks like a hearing aid which is designed to delivery broadband pink sound into the ear.  The other delivery system is by playing a pink sound CD which is available through this network (see Helpfull Products).

I am about to have an MRI.  What can I do to protect my ears from the loud sound of this procedure?

First of all, you need to practice putting foam earplugs in correctly. Most people are clueless on how to do that. If you do it properly you will have a hard time hearing people talk to you. After you put the foam earplugs in correctly, the clinician normally has earmuffs for you to wear on top of that. You can check ahead to see if they have earmuffs. If not, you can purchase earmuffs but they cannot contain any metal in them.

To learn how to put earplugs in correctly, learn from this tutorial:

FittingFoamEarplugs.mp4

Even with all that protection you will tend to focus on the noise you can still hear while having the MRI. Calm yourself because you will be well protected and not incur any injury.

Can the sound of a dentist's drill cause or worsen tinnitus or hyperacusis?

Jack Vernon, Ph.D. wrote, "There is no doubt that dental drilling can exacerbate tinnitus (or hyperacusis) in some patients, and I'd much rather be cautious than sorry.  For dental drilling, I always recommend 5 seconds of drilling then 10 seconds off - 5 on, 10 off - until the job is finished.  The sound is directly conducted to the inner ear by bone conduction, and wearing ear protection will only serve a partial purpose.  Some dentists charge extra for the "5 on/10 off" approach, but most willingly cooperate.  The impact that noise has on hearing is controlled by two elements: the intensity of the sound (how loud it is) and the duration of the sound.  We cannot control the intensity for the dental drill, but we can control the duration of the exposure.  Vernon and Sanders: Tinnitus - Questions and Answers, 2001, pp. 61-63

My ears are sensitive to all sounds, my internist put me on an antihistamine and said it will probably go away in a few weeks.  It hasn't gone away and now my internist says I should give it more time.  If it doesn't improve he says I will just have to learn to live with it.  What should I do?

It is am amazed at how loyal patients are to their doctors when they offer no options or don't have the where-with-all to look into the problem and help their patient.  We applaud doctors who contact the network and ask for any information they can offer to their patient because they know little to nothing about hyperacusis.  The first thing you should do is find a clinician who specializes in treating hyperacusis. Visit this link: http://www.tinnitus-pjj.com/referral.html  It is likely you will have to travel to find a specialist but to do anything else is wasting your time and your money.  The sooner you seek help the sooner you will improve your tolerances to sound.

Rather than go through retraining therapy (TRT) I think I will just try bucking it out on my own and be careful when I am exposed to any loud noise.  Is there anything wrong with that approach?

If you have hyperacusis and your life has been significantly impact by the noise of your everyday surroundings then you have two options.  Your way may improve your sensitivity to sound but the progress will be very slow.  Without the proper counseling from a qualified clinician you will have no way to track your progress and get answers to the many questions that all individuals have who are living a life with hyperacusis (overprotecting, phonophobia, ear pain, etc.).  The other option is to embark on a focused treatment that will help you recover in a timely manner so you can get on with your life and not evaluate every single thing you do in terms of how much noise it is going to generate. 

I don't know if noise is the reason I got myself in this predicament but I can't imagine using noise to get me out of it.  I don't like the idea of listening to noise.  At this point I want total quiet! 

Anyone with severe hyperacusis can relate to those feelings.  Sometimes we waste an awful lot of time trying to figure out how we got hyperacusis.  This can be a waste of time and postpone our recovery.  Our survival instinct is strong when we have been injured.  In the case of hyperacusis everything inside of us tells us to isolate ourselves from noise.  All clinicians would discourage you from doing that.  I know that when I first came down with severe hyperacusis, at the end of the work day my ears were so worn out being in the company of people that I could not even tolerate the sound of my children whispering.  At that point I was hearing at minus decibel levels.  Yes, my ears did need a rest but only for a short time before I needed to embark on the proper treatment.  You need a qualified clinician.  They will rule out any physical problems which could have made your ears more sensitive.  They will, ever so gently, test your sound tolerances to determine the degree of your sensitivity.  They will explain what has happened to your ears.  After all, we all want to know what really happened here!  They will prescribe a sound therapy for you that is ever so gentle.  It will not only improve your tolerances to sound but make your ears less vulnerable to any setbacks.

I am more than willing to make an appointment with a qualified clinician but travel is very difficult for me right now.   My children all live out of town.  I told them if they want to see me they have to come here so I don't have to ride in a car for any amount of time.  I can't imagine flying in an airplane and driving in a car to see a qualified clinician.  What am I supposed to do? 

That is a valid question and one that troubles many hyperacusis patients.  I suggest you buy a pair of Bose QuietComfort 2 noise canceling earmuffs from http://www.bose.com/controller?event=view_product_page_event&product=qc2_headphones_index. Using these noise cancellation earmuffs with earplugs will get you to your appointment and back without any worry of further collapsing your sound tolerances.  Yes, I know you will still worry but believe me I am telling you this because I have done it and so have many other hyperacusis patients.

I have just started Tinnitus Retraining Therapy and find that some days my ears feel more sensitive than others.  Is this normal? 

You know, aside from hyperacusis, some days we get up and we feel rested and feel like a million bucks and other days we seem to be pulling our weight around until it's time to go to bed.  Life with hyperacusis is no different.  When you are doing TRT your ears are being rehabilitated.  Rehabilitation is a committment to become healthy.  The beauty is in the results.  As you proceed though TRT you will eventually feel that your ears yearn for the broadband sound and it is having a healing effect on your ears.  Yes, there will be days when you hear an unexpected loud sound but think of that as a positive rather than a negative.  This therapy was designed specifically for hyperacusis and the success rate is phenomenal.

My family thinks I am making this whole thing up.  I feel like I have nowhere to turn.  Someone in my family even suggested I go see a shrink.

This breaks my heart when I hear stories like this.  My first suggestion would be that you print them out the information off our website.

http://www.hyperacusis.net/hyperacusis/hyperacusis+brochure/default.asp 

This should get there attention.  Next you need to get to a qualified clinician. See the link above in question #1.   If they have any questions or encourage them to write into the network at earhelp@yahoo.com

There is no qualified clinician in our state.  I am living on welfare and cannot afford the travel or expense of TRT.  What am I to do? 

The network offers a broadband pink noise CD and guideline for a suggested donation of $15.00 for you to start sound therapy. This is no way replaces TRT.  You will not have the benefit of tracking your progress and receiving the valuable directive counsel from a clinician who can answer your questions throughout TRT.  However, if your options are this limited it is imperative that you embark on sound therapy to improve and be able to provide for you family.  To this end, the network feels a moral obligation to help those who are financially challenged and have few options available to them.  The tool – pink noise is clearly the answer to our recovery.  The network can provide you with this tool.  For more information on this visit this link:

http://www.hyperacusis.net/hyperacusis/pink+noise+cd/default.asp

How do I clean the wax out of my ears?  My tinnitus seems worse and I think it is because my ears have too much wax in them.  My doctor wants to irrigate them but I read once that this can make things worse.

You are right.  Do not let anyone irrigate your ears because it can exacerbate your condition.  If you need to have excessive wax removed it is best that you use an ear wax softener.  If that does not do the trick then first use an ear wax softener then have an ear doctor manually remove the wax from your ears.  Some doctors insist on using irrigation (because it is quick and fast).  Remember, the doctor is working for you – not the other way around.  Be assertive.  If the doctor won't do it, go somewhere else!  Your ears will be the better for it.  Aside from that, as Dr. Chip suggests "The wax in your ears is there for protection.  Much like you would think of protecting your fine furniture with wax.". 

What is the success rate for Tinnitus Retraining Therapy?

Dr. Pawel Jastreboff says 90%.  Some years ago the network sampled patients who had completed TRT and our rate of success was 91%.  The key here is that you complete the program.

Why do my ears feel like there is pressure on the eardrum? 

Myriam Westcott, Audiologist explains, "In many people with hyperacusis, an increased activity develops in the tensor tympani muscle in the middle ear as part of the startle response to some sounds. This lowered reflex threshold for tensor tympani contraction is activated by the perception/anticipation of loud sound, and is called tonic tensor tympani syndrome (TTTS). In some people with hyperacusis, the tensor tympani muscle can contract just by thinking about a loud sound. Following exposure to intolerable sounds, this contraction of the tensor tympani muscle tightens the ear drum, which can lead to the symptoms of ear pain/a fluttering sensation/a sensation of fullness in the ear (in the absence of any middle or inner ear pathology)."

I don't know if I have hyperacusis or recruitment.  What is the difference? 

Dr. Stephen Nagler has the best advice here.  He states: "There are many misconceptions about hyperacusis and recruitment.  Hearing professionals often oversimplify the concept of recruitment by stating that when hyperacusis occurs in a person with hearing loss, it is "recruitment."  Moreover, you and I have both heard folks with severe hyperacusis claim that "my hyperacusis is so bad that I must have recruitment, too."  In order to answer your question, then, I feel it is very important that these terms are defined properly.  (Or at the very least, that you understand how "I" am defining them. (1)  Hyperacusis is a decreased threshold to discomfort from sound.  It can range from a person who is mildly uncomfortable in a restaurant setting wherein all the rest of the people at the table have no discomfort at all ... to a person who has profound discomfort from many of the sounds encountered in daily life.  TRT and other desensitization techniques can be highly effective in treating hyperacusis.  (2) Recruitment is something completely different.  Recruitment is the rapid growth of perceived loudness for those sounds located in the pitch region of a hearing loss.  (This is Jack Vernon's definition.)  So let me give you an example.  My father had a significant hearing loss for several years before his death at the age of  89.   I could say, "Dad."  He heard nothing, and he of course did not respond.  So I'd say it a bit louder.  Still nothing.  A bit louder than that.  Still nothing.  And then ... just a very tiny bit louder.  The response:  "Stop yelling so loud, Steve, I hear you just fine.  Tone it down a bit, will you!"  And THAT'S recruitment - a *rapid* growth of perceived loudness in a pitch region containing hearing impairment.  (And it is very difficult to convey to a person with significant hearing loss that the time he hears my voice at a level uncomfortable to his ears ... was actually the *fourth* time I tried to get his attention.)  This phenomenon occurs because at some decibel level, the normal hair cells adjacent to the damaged hair cells (corresponding to the frequency of a hearing loss) are "recruited."  At the decibel level at which these normal hair cells "kick in," perceived loudness shoots up rapidly, causing discomfort.  My professional opinion is that TRT and various desensitization protocols do not help in these cases... what is required is hearing aids (with compression, if the recruitment is severe).  BUT - just because a person has some hearing loss and also has sound sensitivity ... it does not mean that the sound sensitivity is due to recruitment.  Hyperacusis can occur in people with hearing loss!  Unfortunately there is no "test" which can be given to a person with hearing loss and sound sensitivity to determine what percentage of the sound sensitivity is actually due to recruitment.  The only thing we can say for certain, in fact, is that if a person has normal hearing, he or she cannot have recruitment.  As a guideline, then, at our clinic if a person with sound sensitivity has a hearing loss not severe enough to warrant hearing aids, we would initially treat that sound sensitivity with TRT or another desensitization protocol.  Even if hearing aids WERE warranted, we would encourage exposure to environmental sound while wearing hearing aids (as in TRT) and only go to compression hearing aids if that approach failed after a concerted effort on both our part and the patient's part.

Is it possible for children to have hyperacusis?

It is possible but rare.  It is not uncommon for children to have hypersensitive hearing.  Some children react strongly to loud sounds.  This is partly due to the fact that children have little to no hearing loss and can hear at frequency levels teenagers and adults cannot.  Understand this, the same two children with the same hearing can react very differently to a noise stimulus.  One with view the loud noise (i.e. fireworks) as exciting and fun while the other will view it as annoying and upsetting.  So what is a parent to do.  If the noise is very loud it is important to acknowledge to the child that it IS too loud.  There is nothing wrong with offering the child ear protection or putting more distance between you and the sound source.  If a strong reaction develops from many sound stimuli your child may have hypersensitive hearing.  If it the reaction becomes so prevalent as to affect their daily life the child's a distortion product otoacoustic emission test (DPOAE) may be performed to tell the status of the outer hair cells.  This can be done even without a young child's cooperation (when calm, sleeping or even sedated).  If the child can communicate openly then a loudness discomfort level (LDL) test can be performed.  Another component which may come into play is if a child develops a fear of noise (phonophobia).  For this reason again, it is important to acknowledge a sound as being very loud, if it IS very loud and try to either accommodate the child into a more noise friendly environment or offer ear protection (children ear plugs or children ear muffs).

This is good advice from Marsha Johnson, Audiologist:

Four year olds are cute little things and can get hyperacusis from a variety of things and can recover with the sound therapy in the form of environmental stimulation and I am glad it is working!

Four year olds also have big imaginations! Sounds can be kind of scary but we can switch that around with a story. Tell him a story about a lovely ocean where the water is bright blue and colorful fish swim around and mermaids play and whales spout and the ocean makes a wonderful music and the music sounds like a lovely water sound and it goes like this, shhhhhhhh! When we hear that sound we can always think of this marvelous story where all these lovely things live and imagine that pretty blue water and the playful fish and mermen and whales!

Maybe you can plan to add to his night time noise with a great fish tank with a filter that blows and goes shhhh all the time, too. Kids love fish and a set up can be obtained for a reasonable cost and some colorful fish installed and he can watch them swim around and help feed them once a day (be careful!) and learn an enjoyable hobby at a young age.

When the kids are young, we cannot just tell them, listen to this it will make you better, we need a story to go along with it and then they will really enjoy it and later, forget about it, it will seem normal and your son may grow up to be someone who likes fan on at night because he will feel sleepy when he hears that magic sound!

Hope this helps.

Often these sound programs only last a while, maybe six months to a year, and then the problem is solved and things go on as normal.

Many kids with constant ear infections can develop hyperacusis due to the blockage of the middle ear space with material that acts like an ear plug, then when this clears, the ears are too sensitive! Toxins in the material (infection) can also act as acids and irritate the middle ear structures, leaving some scarring or adhesions, and these take time to heal.) Been there with our oldest child, this may not apply, but is useful info, I hope.

One time I helped a young adult with Down's Syndrome who had H from ear infections and he did very well and recovered to normal over some months.

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