Hyperacusis

HYPERACUSIS ONSET

Hyperacusis may develop with a number of conditions affecting the auditory pathway (including acoustic shock injury), Meniere’s Disease, otosclerosis, perilymph fistula, Bell’s Palsy), psychiatric disorders, neurological injuries and disorders (including head injury, migraine), adverse reactions to some medications, autistic spectrum disorders, Lyme Disease, chronic fatigue syndrome and fibromyalgia.

Acute acoustic trauma is one of the most common causes for the onset of hyperacusis and quite often misophonia, phonophobia and even low to catastrophic tinnitus may be present as well. With the onset of hyperacusis patients may experience some other problems connected to usual development of anxiety and depression, which have profound effects on hyperacusis strength. Traumatic Brain Injury is known to produce many problems within the auditory system, and almost always causes hyperacusis, tinnitus and hearing loss or significant hearing loss worsening. Some less known causes of hyperacusis may be connected to stapedectomy or spinal problems.

Hyperacusis is more common than we would usually think. The prevalence of hyperacusis in adults is estimated to be between 7% and 23% of the population (Jastreboff and Jastreboff 2000).

HYPERACUSIS CAN BE DEFINED AS AN ABNORMALLY STRONG REACTION TO SOUND OCCURING WITHIN THE AUDITORY PATHWAYS (Jastreboff, 2000)

Hyperacusis is causing negative reactions to sound, with strength of reactions depending only on its physical characteristics (sound spectrum and intensity). The activation of the limbic and autonomic nervous system occurs only secondarily. The functional connections between the auditory, the limbic and autonomic nervous system are normal. (Jastreboff and Hazell, 2004).

When hyperacusis develops, everyday sounds appear unnaturally prominent and increasingly louder. Following exposure to some or many of these sounds, a temporary increase in tinnitus ( if present) and/or hyperacusis may be noticed, and escalating sensations in the ear may develop, such as ear pain, a popping, a fluttering sensation or an intermittent fullness. This reaction can generalize to include more and more sounds. As a result, people may come to believe that their ears are no longer able to physically tolerate these sounds and/or that these sounds are causing damage to their ears or hearing and that they should be avoided. The escalating anxiety about the effects of exposure to these sounds can lead to the development of misophonia and phonophobia.

HYPERACUSIS, MISOPHONIA, PHONOPHOBIA AND DECREASED SOUND TOLERANCE CONNECTION

Hyperacusis, misophonia, phonophobia, decreased sound tolerance or even tinnitus do not have any relation to hearing thresholds!

Patients with these problems may have normal hearing or hearing loss. Approximately 40% of tinnitus patients exhibit some degree of decreased sound tolerance, with 27% requiring specific treatment for hyperacusis. “Conversely, a study of 100 patients with hyperacusis showed that 86% of them suffered from tinnitus” (Anari et al., 1999) So, hyperacusis and tinnitus frequently coexist, but hyperacusis can be an exclusive problem.

Most patients affected by the hyperacusis presence are going to show symptoms of some other conditions which are known to be very common in almost all of hyperacusis cases and to coexist with it. There is a significant group of people whose lives are significantly affected in the negative manner by the sounds not significant to other people and who suffer due to decreased tolerance to sound. This means that in this case not only loudness of the sounds, but just the nature and characteristic of some sounds are know to cause a very strong emotional reactions.

Over time a very strong connection between the auditory system and the limbic and autonomic systems is becoming established and patients will experience onset of misophonia. Phonophobia is going to manifest itself by causing more and more fear of possible presence of certain sounds in the patient’s listening environment. Phonophobia is known to cause a very real and severe problems for the people who are affected by the presence of this condition. It is know to severely limit the ability to work or to function in the unknown listening environments and even to cause highly elevated levels of anxiety in the “safe” and controlled environments.

Anxiety and panic attacks may become very frequent and they can be very severe in strength, regardless even of what is happening in the patient’s listening environment. Presence of all three conditions described above is by itself a very complex and serious problem which is often referred to as a decreased sound tolerance (DST). Unfortunately, most patients affected by DST are known to report tinnitus related problems as well – with the tinnitus alone known to be a very series problem by itself.

CATEGORY 4 CATASTROPHIC TINNITUS WITH A DECREASED SOUND TOLERANCE OR SEVERE HYPERACUSIS PRESENCE COMBINATION

Catastrophic level of tinnitus almost always has a strong decreased sound tolerance elements presence. Combined effect of all elements such as severe or extreme levels of hyperacusis with the strong misophonia and phonophobia symptoms with a very high ( usually extreme or severe ) anxiety levels are known to have a devastating effect on the patients life. Another typical addition to all symptoms listed above comes from ” tension headaches ” caused by a very high levels of anxiety and stress. In addition to aliments described above – there is also a complete lack of concentration and lack of ability to continue in a career. Falling a sleep seems almost impossible even with a television set or radio blaring. People suffering from such extreme tinnitus wake often in the night unable to fall back asleep and are unable to function in practical everyday sense.

HYPERACUSIS AND DECREASED SOUND TOLERANCE (DST) TREATMENT IS USED FOR MORE THAN 20 YEARS , AND IS KNOWN TO BE VERY SUCCESSFUL WITH A RATIO OF SUCCESS OF ABOVE 90% IN ALL LEADING HYPERACUSES CLINICS WORLDWIDE

Evaluation and assessment of decreased tolerance to sounds is included as a must (obligatory) element of hyperacusis / decreased sound tolerance treatment. While patients reactions to some sounds may be the same – treatments are distinctively different and known to have negative effects on conditions they should be not used to treat. Assessment allows us to determine the best possible course of action which should be taken to remove or significantly hyperacusis and all connected to hyperacusis presence problems from the life of our patient efficiently.

Complete hyperacusis assessment takes up to 2 hours and also includes tests which can be used to detect presence of some other conditions such as decreased sound tolerance or others.

Once the mechanism of hyperacusis has been understood, treatment protocols as well as practical self-management strategies to assist desensitization and reduce auditory hypervigilance, personalized to suit each person’s individual coping style, can be developed. Also patients are provided with extensive sessions of specialized cognitive behavioural therapy, directive counselling and mindfulness based stress reduction program and specialized directive counselling sessions. Sound enrichment and precision low level sound stimulation therapy are required as part of the desensitization process.

Please be advised that usage of hearing protection (earbuds, earplugs, earmuffs), noise hearing aids, maskers, or hearing aids with maskers may cause worsening of the hyperacusis, decreased sound tolerances, misophonia, phonophobia or tinnitus symptoms. Exposure to loud sounds as well as to silence or staying quiet listening environments should be avoided.

Sound enrichment and precision low level sound stimulation therapy may involve the fitting of wearable ear level instruments – providing some means of controlled noise protection and a custom auditory system stimulation affecting some other brain centers and parts. Phonophobia, requires very precise management strategies. They need to be individually developed and usually may for an example involve usage of the brain conditioning protocols.

Our brain is a very highly plastic organ regardless of our age. It’s constantly reorganizing and developing new neural connections. This means that we are able to retrain our brain to reverse the process which has led to tinnitus distress, hyperacusis, misophonia or decreased sound tolerance.

Treatment needed in order to achieve habituation and to provide desensitization to intolerable external sounds is a very gradual process. It takes on average two years to provide patient with a complete relief from hyperacusis, decreased sound tolerance and tinnitus ( in case where tinnitus is also present ) with the duration of the treatment being affected by the strength or severity of all, or some of the conditions present. Significant improvement is usually experienced by patients after two or three months from the beginning of the treatment.

Hyperacusis Treatment

We are proud to provide our patients with a successful:
Tinnitus, Hyperacusis And Misophonia Treatment
conducted accordingly to the American Academy of Otolaryngology – Head and Neck Surgery Foundation,
First Clinical Practice Guideline on Tinnitus to more than 300 patients annually.

We are conducting and performing Tinnitus, Hyperacusis & Misophonia Treatments only with the family physician’s approval after no other medical issues are present or relevant. Still, a referral is not needed but is recommended. Treatment is based on a series of visits with the initial assessments, treatment and follow up sessions and may take up to 24 months.

TREATMENT IS BASED ON USING, COGNITIVE BEHAVIORAL THERAPY or its elements, SOUND THERAPY and/or TINNITUS RETRAINING THERAPY which may include a combination of devices or noise generators and individual counseling. People treated will be using hearing aid / noise generator combination covered partially by OHIP ( ADP ) and all private insurance plans as well as work benefits, ODSP, WSIB, and Ontario Works. Veterans are providing full coverage of the cost of instruments and treatments.

MEASURED AND VERIFIED TRT TREATMENT RATIO OF SUCCESS IS ABOVE 90%.

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