Hyperacusis

	WikiDoc Resources for Hyperacusis
Articles
Most recent articles on Hyperacusis Most cited articles on Hyperacusis Review articles on Hyperacusis Articles on Hyperacusis in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Hyperacusis Images of Hyperacusis Photos of Hyperacusis Podcasts & MP3s on Hyperacusis Videos on Hyperacusis
Evidence Based Medicine
Cochrane Collaboration on Hyperacusis Bandolier on Hyperacusis TRIP on Hyperacusis
Clinical Trials
Ongoing Trials on Hyperacusis at Clinical Trials.gov Trial results on Hyperacusis Clinical Trials on Hyperacusis at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Hyperacusis NICE Guidance on Hyperacusis NHS PRODIGY Guidance FDA on Hyperacusis CDC on Hyperacusis
Books
Books on Hyperacusis
News
Hyperacusis in the news Be alerted to news on Hyperacusis News trends on Hyperacusis
Commentary
Blogs on Hyperacusis
Definitions
Definitions of Hyperacusis
Patient Resources / Community
Patient resources on Hyperacusis Discussion groups on Hyperacusis Patient Handouts on Hyperacusis Directions to Hospitals Treating Hyperacusis Risk calculators and risk factors for Hyperacusis
Healthcare Provider Resources
Symptoms of Hyperacusis Causes & Risk Factors for Hyperacusis Diagnostic studies for Hyperacusis Treatment of Hyperacusis
Continuing Medical Education (CME)
CME Programs on Hyperacusis
International
Hyperacusis en Espanol Hyperacusis en Francais
Business
Hyperacusis in the Marketplace Patents on Hyperacusis
Experimental / Informatics
List of terms related to Hyperacusis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Norina Usman, M.B.B.S [2]

Overview

Hyperacusis is a condition characterized by an over-sensitivity to a specific frequency of sound or intolerance to reasonable environmental sounds. A person with hyperacusis has difficulty accepting everyday sounds; some sounds may seem offensively loud to that person but not to others. In hyperacusis, a person gives inappropriate or exaggerated responses to sounds that are neither uncomfortable nor threatening loud to an average person; even low-intensity sounds can elicit the reaction.

Classification

Based on the symptoms, hyperacusis may be classified as cochlear and vestibular hyperacusis.^[1]

Cochlear hyperacusis:

The most common form of hyperacusis
Presents with ear pain and general intolerance to any sounds that most people don't notice or consider unpleasant.
Crying spells or panic attacks may result from cochlear hyperacusis.
Most of the time cochlear hyperacusis is associated with tinnitus.

Vestibular hyperacusis:

Associated with dizziness, nausea, or a loss of balance triggered by certain pitch sounds.
Anxiety, stress, and phonophobia may be present in both types of hyperacusis.
High risk for developing avoidant behavior to avoid a stressful sound situation.

Pathophysiology

Hyperacusis can be developed because of damage to the inner ear or hearing apparatus, affecting efferent part of the auditory nerve, and fibers that come out from the brain that control sounds.^[2]^[3]
In this process, tissues of the auditory nerve are damaged, though the hair cells that permit us to hear pure tones remain integral.
It can be as a result of injury to the neurological system of the brain. In some cases, hyperacusis may be triggered by a vestibular disorder.
Stapes hypermobility can also be one of the causes of peripheral hyperacusis.
Situations that comprise paralysis of the facial nerve (i.e., Ramsay-Hunt syndrome, Bell’s palsy, and Lyme disease) are involved in the causes of the condition.
Hyperacusis increases in extent during anxiety, tiredness, or stress.
The mechanism involved during stress, include endogenous dynorphins release into the synaptic region underneath inner hair cells.
It potentiates the neurotransmitter glutamate, triggering sound to be seeming with excessive noise.

Causes

Common causes of hyperacusis include:

Severe head trauma
Facial nerve dysfunction (to Stapedius)
Surgery
Ear irrigation
TMJ (Temporomandibular joint disorder)
Adverse drug reaction
Williams Syndrome
Autism
Bell's palsy
Ménière's disease
Asperger syndrome
Superior Canal Dehiscence Syndrome
Chronic ear infections
Minor Head Injury
A vestibular disorder

Differentiating hyperacusis from other diseases

On the basis of signs and symptoms, hyperacusis must be differentiated from misophonia, phonophobia, tinnitus, William syndrome, Lyme disease, migraine.^[4]^[5]

	Symptoms			Physical examination
Diseases	Clinical manifestations						Para-clinical findings	Gold standard
	Symptoms			Physical examination			Para-clinical findings
	Negative emotional reaction	Ringing in the ears	Psychiatric disorders	Hearing loss	Sound sensitivity	Loudness discomfort level
Misphonia	+	-	+	+/-	-	-	Limbic system involved	Clinical diagnosis Certain sounds trigger emotional or physiological responses
Phonophobia	+	-	+	+/-	-	-	Limbic system involved	Clinical diagnosis Fear of loud sounds
Tinnitus	+/-	+	-	-	+	+	8th cranial nerve palsy/ auditory system involved	Audiological exam
William Syndrome	+/-	-	+/-	+	+	+	Genetic disorder	Micro-array analysis/FISH and audiological exam
Lyme Disease	+	+	+/-	+	+	+	Auditory system involved	Audiological exam
Migraine	-	+	-	-	+	+/-	Trigeminal ganglion stimulation	Clinical diagnosis

Epidemiology and Demographics

Incidence

The incidence of hyperacusis is approximately 1 in 50,000 people.

Prevalence

The overall prevalence of hyperacusis among children and adolescents is between 3.2% to 1.7%. In adults, prevalence rate is between 8% to 15.2%.

Age

Hyperacusis is commonly seen in individuals with any age group.

Gender

Hyperacusis affects men and women equally.

Race

There is no racial predilection to hyperacusis.

Natural History, Complications, and Prognosis

Natural History

In the case of a hyperacusis, patients can present with.

Complications

Common complications of hyperacusis depend on the etiology.

Prognosis

Depending on the extent of the disease progression at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.
Patients with hyperacusis have profound psychological influence, patients presenting with self-harm or suicidal ideation.

Hyperausis Diagnosis

Diagnostic study of choice

Pure tone audiometry is the gold standard test for the diagnosis of hyperacusis.

Loudness discomfort level( LDL) measured in decibels (dB); LDL decreased by 16–18 dB than the general population is diagnostic of hyperacusis.
95% of patients with hyperacusis have LDL ≤ 77 dB (average LDL in a normal person is 100 dB).

History and Symptoms

The hallmark of hyperacusis is sensitivity to sounds.
A positive history of over-sensitivity or distress to particular sounds is suggestive of hyperacusis.
The most common symptoms of hyperacusis include annoyance, ear pain, loudness, and tinnitus.

Physical Examination

Physical examination of patients' hyperacusis is usually remarkable for fear, irritability, and avoidance behavior.

Laboratory Findings

There are no diagnostic laboratory findings associated with hyperacusis.

CT scan

There are no CT scan findings associated with hyperacusis.

MRI

There are no MRI findings associated with hyperacusis.

Other Diagnostic Studies

Health questionnaires may be helpful in the diagnosis of hyperacusis. Findings suggestive of hyperacusis include:

HQ score of ≥ 22 is diagnostic of hyperacusis.
Disability
Functional impact
Psychological factors
Impacted quality of life

Treatment

The most common treatment for hyperacusis is retraining therapy that includes:^[6]

Tinnitus Retraining Therapy (TRT), a treatment originally used to treat tinnitus, uses broadband noise to treat hyperacusis. By listening to broadband noise at soft levels for a disciplined period of time each day, patients can rebuild (i.e., re-establish) their tolerances to sound.
Pink noise can also be used to treat hyperacusis.

Another possible treatment include:


Non- pharmacological therapy	Surgical Treatment	Alternative treatments
Cognitive Behavioral Therapy	Round window reinforcement	Excercise, yoga, meditation
Tinnitus retraining therapy (TRT)	Oval window reinforcement	Massage, relaxing therapy, hypnosis
Directive Counselling		Vitamin and supplements

People

Stephen Merritt, of The Magnetic Fields, suffers from this condition.

External links

References

↑ Baguley DM (December 2003). "Hyperacusis". J R Soc Med. 96 (12): 582–5. doi:10.1258/jrsm.96.12.582. PMC 539655. PMID 14645606.
↑ Jansen EJ, Helleman HW, Dreschler WA, de Laat JA (January 2009). "Noise induced hearing loss and other hearing complaints among musicians of symphony orchestras". Int Arch Occup Environ Health. 82 (2): 153–64. doi:10.1007/s00420-008-0317-1. PMID 18404276.
↑ Paulin J, Andersson L, Nordin S (2016). "Characteristics of hyperacusis in the general population". Noise Health. 18 (83): 178–84. doi:10.4103/1463-1741.189244. PMC 5187659. PMID 27569405.
↑ Schwartz P, Leyendecker J, Conlon M (November 2011). "Hyperacusis and misophonia: the lesser-known siblings of tinnitus". Minn Med. 94 (11): 42–3. PMID 22413649.
↑ Jüris L, Andersson G, Larsen HC, Ekselius L (April 2013). "Psychiatric comorbidity and personality traits in patients with hyperacusis". Int J Audiol. 52 (4): 230–5. doi:10.3109/14992027.2012.743043. PMID 23244506.
↑ Andersson G, Jüris L, Kaldo V, Baguley DM, Larsen HC, Ekselius L (2005). "[Hyperacusis--an unexplored field. Cognitive behavior therapy can relieve problems in auditory intolerance, a condition with many questions]". Lakartidningen (in Swedish). 102 (44): 3210–2. PMID 16329450.

[pmid14645606-1] Baguley DM (December 2003). "Hyperacusis". J R Soc Med. 96 (12): 582–5. doi:10.1258/jrsm.96.12.582. PMC 539655. PMID 14645606.

[pmid18404276-2] Jansen EJ, Helleman HW, Dreschler WA, de Laat JA (January 2009). "Noise induced hearing loss and other hearing complaints among musicians of symphony orchestras". Int Arch Occup Environ Health. 82 (2): 153–64. doi:10.1007/s00420-008-0317-1. PMID 18404276.

[pmid27569405-3] Paulin J, Andersson L, Nordin S (2016). "Characteristics of hyperacusis in the general population". Noise Health. 18 (83): 178–84. doi:10.4103/1463-1741.189244. PMC 5187659. PMID 27569405.

[pmid22413649-4] Schwartz P, Leyendecker J, Conlon M (November 2011). "Hyperacusis and misophonia: the lesser-known siblings of tinnitus". Minn Med. 94 (11): 42–3. PMID 22413649.

[pmid23244506-5] Jüris L, Andersson G, Larsen HC, Ekselius L (April 2013). "Psychiatric comorbidity and personality traits in patients with hyperacusis". Int J Audiol. 52 (4): 230–5. doi:10.3109/14992027.2012.743043. PMID 23244506.

[pmid16329450-6] Andersson G, Jüris L, Kaldo V, Baguley DM, Larsen HC, Ekselius L (2005). "[Hyperacusis--an unexplored field. Cognitive behavior therapy can relieve problems in auditory intolerance, a condition with many questions]". Lakartidningen (in Swedish). 102 (44): 3210–2. PMID 16329450.

[1]

[2]

[3]

[4]

[5]

[6]