Decreased Sound Tolerance: Hyperacusis & Misophonia
Bothered by loud noises or specific sounds? You may be suffering from Decreased Sound Tolerance: hyperacusis and misophonia. If you suffer from some sort of negative reaction when exposed to sound that would not trigger the same response in the average listener, then you’re experiencing Decreased Sound Tolerance (DST).
DST can cause you to feel a range of negative reactions from dislike or discomfort to pain, distress, anxiety, annoyance or even fear. DST often comes hand and hand with tinnitus and hearing loss, and can be reported in many medical conditions including head injuries, migraines, Lyme disease, Williams Syndrome, autism, Bell’s palsy, benzodiazepine withdrawal, and post stapedectomy. However, it’s not unusual for DST to be reported as the sole complaint.
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What exactly are Hyperacusis and Misophonia?
Hyperacusis occurs in about 25-30% of tinnitus patients and is the experience of moderately-intense sounds (e.g., dishes clanging) being perceived as overly loud and annoying. In other words, there is a negative reaction to sound that depends on only the physical characteristics of the sound itself (e.g., loudness).
Misophonia, experienced by about 60% of tinnitus patients, is a dislike, fear, or negative reaction to a specific sound with a certain pattern and meaning (e.g., chewing of a specific person). Reactions are usually context-specific (e.g., eating at a restaurant would not bother you, but eating at home does). Unlike hyperacusis, someone with misophonia can tolerate a high level of other sounds, such as music or traffic noise. Patients with misophonia tend to have an increased awareness of external sounds as well as somatosounds (internal body sounds, like chewing).
Other terms you’ll see associated with misophonia include:
- Phonophobia, a specific case of misophonia where fear is the dominant emotion
- Selective Sound Sensitivity Syndrome (4S), another variation of misophonia that includes only very soft particular noises, called Trigger Sounds, which are often associated with oral functions (e.g., chewing, lip licking, smacking, or breathing).
Although hyperacusis and misophonia differ in terms of how we approach treatment, there is no fundamental difference with how you treat misophonia vs phonophobia vs 4S, so for simplicity’s sake, we use the term “misophonia”.
Treatments for DST
The first step is a thorough consultation with us. We’ll listen to your concerns rather than tell you to “just live with it.” To effectively treat DST, we consider all the dimensions of the condition:
- Biological dimension: what’s going on in your ears and brain
- Psychological dimension: your emotions and your beliefs regarding your situation
- Social dimension: how you are dealing with the outside world (e.g., are you only able to function in busy environments like restaurants if you wear hearing protection?)
- Time dimension: how has your situation developed over time? Has it been gradual? Or was it triggered by something specific (e.g., head injury after a car accident)?
Depending on the complexity of your specific case, you may see more than one healthcare professional from a variety of disciplines. For example, if we suspect that there’s an underlying medical condition that’s causing your symptoms, we may refer to you an Ear, Nose, and Throat Specialist.
Depending on whether you have hyperacusis or misophonia (or both), we will recommend sound therapy in different ways. For example, someone with hyperacusis will undergo a desensitization procedure that introduces soft, low-level sound which we gradually increase over time to induce “auditory toughening”; the idea is to gradually desensitize your auditory system. Although white noise is typically used, our rule is to only use sounds that are not annoying or bothersome to my patients. If the idea of listening to noise is not appealing, there are tons of other sound options out there; flexibility is crucial to getting you to restore a sense of control so that we can “reset” your relationship with sound. There are discreet, portable ear-worn solutions as well as table-top sound machines, all the way down to free sound generating apps for your phone.
Appropriate Hearing Protection
We absolutely advocate the use of hearing protection when there’s a chance of exposure to potentially damaging sounds. However, when it comes to DST, it’s not unusual for hyperacusis sufferers to overprotect themselves from everyday sounds by using earplugs or earmuffs even though there’s no chance of harming their hearing.
Overusing hearing protection will make your hypersensitivity to sound worse. Normally, hearing protection is supposed to be used when you’re going to be exposed to dangerously loud sound, like jet engines. It dampens the sound so that even though you will still hear the engine noise, it’s enough to take the edge off so it’s no longer at damaging levels.
What happens if you wear hearing protection when there’s no loud sound? Everything gets dampened, so little to no sound gets up to the brain. However, sound is life and your brain craves stimulation. If it doesn’t get it, it cranks up its internal sensitivity. The lack of stimulation will only make DST symptoms worse. It is the fear that drives earplug use, not the possibility of actual risk.
Not ready to give up your earplugs? We recommend a gradual process of weaning off those earplugs/earmuffs. Or we may suggest suggest investing in a set of custom musician’s earplugs, which contain special filters to dampen sound levels more evenly so that music and speech are clear and natural, not muffled as with regular foam earplugs.
If you’ve been living for DST for quite some time, it can take time to re-establish what are “normal” levels of sound.
h carries information between the cochlea and the brain. With the help of tiny hair cells, the auditory nerve converts sound waves into nerve impulses that travel to your brain. Your brain interprets the sound so you “hear” it as birds chirping, a voice or music. All told, hearing is an amazing process that happens in a split second.earing needs and your lifestyle.
DST itself can cause a great deal of stress (on top of whatever life throws at us). One thing you can to relieve DST yourself is to follow good practices to manage stress in your life, and to engage in relaxing activities. Some examples of relaxing activities include (but are certainly not limited to):
- Taking time for yourself
- Listening to soft music
- Exercising (e.g., yoga)
- Performing your favourite relaxing hobby (e.g., reading a good book)
Other DST sufferers may also benefit from more formal relaxation approaches, such as Progressive Muscle Relaxation (PMR), which teaches your muscles to relax. We can help you find relaxation techniques that will be effective for you.
Questions? DST is complex. We can help you understand the condition and restore your quality of life. Call us today to get answers.