Hypersensitivity to noise (hyperacusis) is what doctors call a general, non-specifically increased hypersensitivity to sound. Those affected can react nervously or aggressively to the barking of dogs, telephone rings and other everyday noises – and sometimes even with tachycardia, high blood pressure and sweating. Here you can find out hyperacusis treatment, symptoms, causes and more.
ICD codes for this disease: H93
Hyperacusis: Even quiet is too loud
People with hyperacusis find even moderately loud or even soft sounds uncomfortable (in one or both ears). Although the volume of such noises is actually well below the pain threshold, those affected perceive them as unpleasant and can trigger symptoms such as restlessness and tachycardia.
Hyperacusis is particularly common in people with tinnitus. Hypersensitivity to noise is rare in childhood.
Other types of noise sensitivity
A distinction must be made between hyperacusis and misophonia (= hypersensitivity to specific sounds, eg scratching the chalk on the blackboard) and phonophobia (= fear of or aversion to certain sounds).
Recruitment also needs to be differentiated. This refers to the sensitivity of some people with internal hearing loss to noises in the frequency range that is (mostly) affected by the hearing loss: Above a certain volume level in the disturbed frequency range, the sound is perceived as excessively loud because the body uses neighboring auditory cells to compensate for the hearing loss recruited. Recruitment is a side effect of sensorineural hearing loss and has nothing to do with general hyperacusis.
Cause of hyperacusis
Hyperacusis presumably arises from the fact that the affected person’s processing and interpretation of the auditory signals is disturbed in the brain.
Normally, the human brain distinguishes important from unimportant noises and ignores the latter. For example, a mother is awake at the slightest noise from her baby, but road noise lets her sleep peacefully. This mechanism does not seem to work in people with hyperacusis.
The reason for this often remains unknown – in many of those affected, neither the underlying causal relationships (etiology) nor an underlying disease can be determined.
Concomitant diseases and influencing factors
The increased sensitivity to noise often occurs in people with ringing in the ears (tinnitus). However, that does not mean that the tinnitus is the cause of the hyperacusis. Hyperacusis is also not the reason for tinnitus. Instead, both symptoms – ringing in the ears and hypersensitivity to noise – can be due to the same damage in the hearing system and can occur together or separately.
Even after a sudden hearing loss, some sufferers report that everyday noises, which would normally be tolerable in terms of volume, are now much too loud.
Many patients with functional pain syndromes (eg fibromyalgia, complex regional pain syndrome) also suffer from hyperacusis.
Hypersensitivity to noise sometimes occurs in the case of unilateral or bilateral facial paralysis (facial paralysis). This can have many causes, for example a stroke, multiple sclerosis, autoimmune diseases, infections (e.g. middle ear infection, “shingles in the ear ” = zoster oticus) or injuries. In many cases, the cause of the facial paralysis remains unknown (Bell’s paresis).
Emotional stress – acute and chronic – can promote the onset of hypersensitivity to noise.
Many migraine patients are also familiar with temporary hyperacusis : During the attacks, those affected find even “normal” noises too loud and uncomfortable.
Sometimes hyperacusis is caused by drugs or other exogenous substances such as acetylsalicylic acid, caffeine, quinine, or carbon dioxide.
Symptoms of hyperacusis
Hypersensitivity to noise can vary in severity. Everyday noises are not only subjectively perceived as unpleasant, they also lead to physical reactions such as tachycardia, increased blood pressure, sweating, tension in the shoulder and neck area, fear or restlessness. Many of those affected withdraw socially and avoid activities in public so as not to expose themselves to unpleasant noises.
As mentioned above, hyperacusis is often associated with other health disorders or diseases – such as tinnitus.
Diagnosis of hyperacusis
First, the doctor asks about the medical history of the person concerned (anamnesis). He also inquires about leisure activities and work. Then follows an ear, nose and throat examination.
In the hearing test, hyperacusis can show normal to very good hearing. Anomalies are found when testing the so-called discomfort threshold: This is the volume above which noises are perceived as unpleasant. This threshold is lower in people who are sensitive to noise.
Depending on the additional symptoms, the doctor will carry out further examinations for more precise clarification.
Hyperacusis treatment
Hyperacusis cannot be solved with earplugs. The focus is on providing the patient with detailed information and advice about the physical and psychological causes and connections of hypersensitivity to noise and how to deal with it (counseling). As part of the psychosomatic treatment, special attention is paid to existing fears : many of those affected are very afraid that their sensitivity to noise will continue to increase and their hearing will be permanently damaged. It is important to take these fears away from the patient.
It is also very important for those affected not to avoid noises or to flee from them (avoidance behavior), because that would only increase sensitivity. Instead, one should learn to endure noise despite the hyperacusis – of course only “normal” noise and no excessive noise that can damage hearing.
It can also be helpful to ensure that there is constant, quiet background noise at home – for example with an indoor fountain, soft music, a CD with nature sounds (such as birdsong) or a fan. The volume should just be perceptible and not disturbing. This is supposed to teach the brain to block out unimportant noises. However, this process of getting used to (habituation) can take a long time (eg several months).
Other treatment options include technical aids such as a noiser (a small device that resembles hearing aids and produces individually adjustable noises) and hearing-specific exercises. They can also help those affected to reduce their hypersensitivity to noise (hyperacusis).
