Clarifying the Use of the Term "Hyperacusis"

Hi folks,

I would like to clarify the use of the term "hyperacusis," because I have seen it used to refer to what I have experienced as two very different phenomena:

1) experiencing ordinary sounds as unpleasantly "too loud"

2) experiencing ear pain (sometimes only a little while later, not right away) from things like music, TV, dishes clanking, etc., but NOT hearing these at a louder volume

This distinction seems to me important.

I only experienced #1, above, at the very start of my symptoms after an acoustic trauma (in Nov. 2017). That is, about two weeks after the initial trauma, I began to hear ordinary sounds as louder than normal. This was before I even developed tinnitus. Fortunately, this (hearing sounds as louder) did not last and has never recurred. I say "fortunately" because it was by far the most distressing symptom I have experienced since the trauma occurred.

#2, however, remains a problem for me over two years later. For me, it results from some kind of exposure to the kind of sound that bothers my ears. That may be a loud sound, but it can just as often be prolonged exposure to a tinny sound. After this exposure, my ears react with pain/fullness to other loud or tinny sounds almost right away. My tinnitus may spike a bit as well, but in general it is pretty under control. It's the ear pain that is problematic. I can render myself less sensitive by avoiding such exposures for awhile (using earplugs with TV for a week and so forth). But it is a possibility that is always present.

To me, then, these two things happened at very different points, and I would say would seem to have quite different mechanisms. But which is hyperacusis?

 

As I understood it #1 is classified as loudness hyperacusis and #2 is pain hyperacusis. They tend to get blurred together, although that's not to say you couldn't have both. I also experienced #1 after my trauma but the unusual loudness of things has dissipated over 2 months. I never had true splitting pain in my ears other than a dull ache, but I still get the fullness which I attribute to TTTS which isn't hyperacusis itself but more specifically the middle ears response to it and the trauma.

 

Depends on your source, The Hyperacusis Network says pain hyperacusis is hyperacusis whereas "loudness hyperacusis" is recruitment. Oftentimes, you also see the term "loudness hyperacusis" or "pain hyperacusis" on TinnitusTalk. There's also a new term for "pain hyperacusis" called noxacusis.

Bryan Pollard said on a recent Tinnitus Talk Podcast episode:

• With pain hyperacusis, earlier this year in talk on treatment for pain hyperacusis, the spokesperson said that we treat pain hyperacusis completely independently now from loudness hyperacusis and it requires a much more tailored approach and, also, we typically don’t expect the same outcomes as we do with loudness hyperacusis.

 

Roughly speaking, they are essentially different medical problems. I define hyperacusis as any version of pain or loudness (or even a combination)/anger/frustration that is highly debilitating -- as in your life is totally changed, your career is altered, your social life is altered, and you possibly struggle to leave your house.

Some places in the literature make it seem vague or common, like it affects 1-5% of the population. This could not be more untrue. Most of us go to expert doctors who have never treated a single patient with this. Personally, I don't know of any friends, friends of friends, or friends of friends of friends who have ever gone many months without being able to talk, drive, or really do anything because of hyperacusis.

My impression is that pain hyperacusis is almost always caused by noise trauma where something is blunt force damaged in the inner ear, but that's not always the case. Loudness/anger/frustration hyperacusis tends to have a variety of causes; it's not even clear where in the inner ear the problem is. Is it the brain? The hair cells? The afferent or efferent nerves? In my case, I have very severe loudness hyperacusis with a totally unknown cause -- it definitely wasn't from noise exposure.

Sadly, I just saw a top-notch ENT, and it was very clear he didn't know what the definition of hyperacusis was. He made me feel crazy for struggling to talk like I had mental illness instead of hyperacusis -- nothing against mental illness, but it's just a misdiagnosis in this case. It turns out this is par for the course for true hyperacusis. This would surely not be the case if this affected 1-5% of the population.