hyperacusis

Hyperacusis is a condition characterized by an abnormal sensitivity to everyday sounds, such that noises that are normally tolerable become uncomfortably loud or painful. It can affect one or both ears, and the degree of sensitivity may vary over time. Hyperacusis is usually not a disease on its own but a symptom or consequence of an underlying auditory or neurological condition.

Causes and associations: It often follows noise exposure or hearing loss, but can also occur after head injury, viral or bacterial inner-ear infections, meningitis, autoimmune disorders, migraines, or exposure to ototoxic medications. It is commonly associated with tinnitus and may be linked to anxiety disorders or autism spectrum disorders in some individuals. The precise mechanism is not fully understood, but theories include altered cochlear amplification and changes in central auditory processing that increase loudness gain.

Diagnosis: Diagnosis is clinical and based on reported reduced sound tolerance. Audiometry and tympanometry may help rule out other conditions. Some clinicians perform loudness discomfort level testing, but results vary and no universal standard exists. Distinguishing hyperacusis from misophonia or phonophobia is important.

Treatment and management: Management is individualized and there is no single cure. Approaches include counseling and education, gradual sound exposure or sound therapy to desensitize tolerance, and, when appropriate, cognitive behavioral therapy or tinnitus retraining therapy. Some patients benefit from amplification or hearing aids with desensitization features. Protective ear devices may be used in very loud environments, though overuse can impede adaptation. Addressing an underlying condition and reducing stress and anxiety can also help.

Prognosis and prevalence: Prognosis varies; some people improve with treatment, while others experience persistent symptoms. The prevalence of hyperacusis in the general population is uncertain, and estimates depend on definitions and assessment methods.