When the world is too loud: understanding hyperacusis
Last updated on 19 April 2012
This article was written by Lucy Handscomb, a Hearing Therapist and member of the BTA's Professional Advisers' Committee
When Anita walked into my office for her first appointment, she was clearly anxious and upset. She explained that since a fairly minor car crash about five years ago, something strange had happened to her hearing. Noises which she had never really thought about before had become irritating and uncomfortable. The music she used to enjoy had become unbearably loud, and she couldn’t concentrate on her everyday tasks at home without first switching off radios and shutting doors. Worst of all, her relationship with her three sons had become tense and irritable. She found herself continuously snapping at them to turn the TV down, switch off their music or talk more quietly. They felt she was being unreasonable, and would snap back. She couldn’t understand it; things just didn’t sound normal any more. Was she going out of her mind?
Anita’s story is fairly typical of somebody with hyperacusis, the usual definition of which is over- sensitivity to moderately loud sounds. Most people find excessively loud noise (such as music in a night club) uncomfortable and these high noise levels can damage hearing. But in hyperacusis, the threshold is much lower and noises which aren’t actually harmful to hearing can seem unbearable. There are many potential triggers- whiplash injury is just one of them- but the desire to switch off or get away from noise is a defining feature. It is unclear just how many people experience hyperacusis, but it is probably around 2% of the population in the UK. Most (but not all) of them also have tinnitus and a significant number also have some degree of hearing loss. This apparent paradox can lead to a particular lack of understanding from other people; “you couldn’t hear me a moment ago, so why are you complaining now that I’m too loud?”
Just knowing that she had a recognised condition with a name- hyperacusis- was the first step on the road to recovery for Anita. She took some information home with her to share with her family, and straight away found that they started to treat her more kindly, checking that the volume of the TV was OK for her and shutting the door before playing music.
Over the next few appointments, we worked on a number of tasks designed to help Anita increase her tolerance to sound. The technique we use is similar to that used by psychologists who are helping people to overcome a phobia. People who are afraid of spiders or lifts or small spaces will naturally go out of their way to avoid or escape from the object of their phobia; taking the stairs or running from the room when there’s a spider in the bath. The problem is that this ‘avoidance behaviour’ re- enforces the phobia, as the person keeps giving themselves the message that this thing is just too awful to face. When they do find themselves face to face with a spider, in spite of their best efforts to avoid it, they feel anxious and panicky. Although hyperacusis is not generally considered to be a phobia (and may have physiological rather than psychological causes), many of the same principles apply. The automatic and natural response to hyperacusis is to avoid or escape from uncomfortable sounds by switching things off, walking a different route or wearing ear plugs. In some cases people avoid going out altogether. The result is that when the person does encounter a loud noise, it seems even more uncomfortable than before and may cause considerable anxiety or distress. A difference is that while it is relatively easy (in the UK at least) to avoid spiders and lifts, avoiding noise entails huge changes in lifestyle, so just living with it isn’t really an option.
Phobias can successfully be treated by using a ‘graded exposure’ technique, and the same technique appears to work well for hyperacusis. People gradually allow themselves to hear sounds which are just above their personal comfort threshold and make a conscious effort to relax, perhaps using slow breathing techniques. This is done often, but for short periods of time. It might involve removing earplugs just before getting home or sitting with the rest of the family in front of the TV for a little while. Once the person feels comfortable in this situation they can extend the time, or begin working on a slightly more challenging task.
With Anita, I have been agreeing on challenges that she works on between appointments. These have included leaving the door open- and letting the sounds her family makes in- while cooking, putting music on while ironing and running the washing machine while cleaning the kitchen. As she has succeeded in each of these tasks, her confidence has increased. Best of all, the positive effect seems to have ‘spread’ to other situations even though she hasn’t worked on these specifically. She still dislikes loud noise, but it is no longer sending her into a spiral of anxiety and distress.
People who are not very severely affected by hyperacusis can quite often overcome it themselves once they know that ordinary environmental sounds are not harming their hearing. A graded exposure plan can be worked out for oneself. Other family members can offer support and encouragement. As Anita found, it is helpful for family and friends to understand something about hyperacusis, but it’s important to make sure they’re not actually making things worse by being over- cautious. If the family is tiptoeing around and talking in hushed voices, this can re-enforce the negative effects of avoidance behaviour. Behaving normally but with consideration is much better.
If hyperacusis is having a more detrimental effect on quality of life it is a good idea to seek specialist help. Most NHS tinnitus clinics will be able to offer therapy for hyperacusis as well. You will probably need to be seen by an ENT doctor first, although in some areas GPs can refer to tinnitus and hyperacusis clinics directly. There are also a few private clinics around the UK.
As well as helping you with the behavioural techniques mentioned above, a therapist can supply you with sound generators. These are small devices worn in or behind the ear, which make a soft, continuous ‘shhh’ sound. They are sometimes used in tinnitus therapy too. There haven’t yet been any large- scale clinical trials investigating their use in hyperacusis treatment, but a lot of people with the condition do seem to find them helpful. They act rather like a cushion between you and the surrounding noise, making things sound less harsh. Normally they are used as a medium- term measure for between about 6 and 18 months. Eventually most people feel able to do without them although some continue to use them in more difficult situations.
Anita is still working towards her ultimate goal of hearing her son perform at an outdoor concert in the summer. She is well on her way and, like many people who are overcoming hyperacusis, her confidence grows every time she manages a new challenge. Although some noises still feel uncomfortable, she is able to let the feeling pass rather than spend time worrying about where the next noise might come from.
Learning to overcome hyperacusis can be a lengthy process and most of the resources you need to do it have to come from within, which makes it very hard work. However the positive side of this is that you are the boss. Once you have got your hyperacusis under your control, you can keep it there.
Picture posed by model. This article originally appeared in Quiet, Summer 2010.
Phobias can successfully be treated by using a ‘graded exposure’ technique, and the same technique appears to work well for hyperacusis