6) Hyperacusis Flashcards
The term “hyperacusis,” has been used for over ____ years
75
Define hyperacisus
Hyperacusis is a hearing disorder commonly described as:
- Altered “tolerance” or “sensitivity” towards certain sounds (Khalfa 2004, 2014).
- Reduced tolerance to sound(s) that are perceived as normal to the majority of the population or the person before the onset of hyperacusis
Hyperacusis may exist with or without ____
tinnitus
Prevalence of Hyperacusis:
̶- Approximately ____ of the general population.
̶- Prevalence of hyperacusis in individuals with tinnitus: Around ____.
̶- Prevalence of tinnitus in individuals with hyperacusis: Around ____.
- 6% to 17%
- 40%
- 86%
Individuals with hyperacusis are more prone to develop ____.
tinnitus
What are two different characteristics/subtypes of hyperacusis?
Phonophobia and misophonia
What is misophonia?
Negative, intense emotional reactions to specific patterns of sounds, or sounds presented in certain situations.
What is phonophobia?
- An unwanted and persistent fear/avoidance of safe levels of sound.
̶- Such as common environmental sounds: traffic, kitchen sounds, doors closing, etc.
What are some common triggers of misophonia (4)?
- Eating and drinking sounds (E.g.: Chewing, crunching, slurping, swallowing, or lip-smacking).
- Breathing noises (E.g.: Sniffling, nose blowing, heavy breathing).
- Mouth and throat noises (E.g.: Coughing, loud kissing, or throat-clearing).
- Repetitive sounds (E.g.: Tapping fingers or toes, ticking clocks, clicking pens, mechanical humming, or water-dripping).
How are reactions controlled for misophonia?
Reactions are controlled by the sympathetic nervous system, in which an acute stress response prepares the body to fight or flee.
What are the 3 types of reactions to misophonia?
1) Emotional reactions
2) Body reactions
3) Behavioural reactions
What are some emotional reactions with misophonia (5)?
- Anger
̶- Anxiety
̶- Disgust
̶- Fear
̶- Irritation
What are some body reactions with misophonia (5)?
̶- Blood pressure increases
̶- Chest pressure or tightness
̶- Goosebumps
̶- Heart rate increases
̶- Sweating
What are some behavioural reactions with misophonia (5)?
- Avoiding situations triggering misophonia
̶- Leaving the area
̶- Verbal or vocal reactions (e.g.: yelling at
people)
̶- Non-violent action to stop the sound
̶- Violent action to stop the sound (rare)
What causes misophonia (2)?
The potential mechanisms are unclear, It may be due to:
̶- Brain structural/functional differences
̶- Family/genetic factors
What are the 4 subtypes of hyperacusis?
1) loudness hyperacusis
2) pain hyperacusis
3) misophonia or annoyance hyperacusis
4) phonophobia or fear hyperacusis
What is loudness hyperacusis?
Perceiving moderately loud sounds as very loud.
What is pain hyperacusis?
- Perceiving pain at a sound level that is much lower than to be perceived as painful by listeners with the majority of the population.
̶- It may be reported as a stabbing pain in the ear or the head.
What is misophonia or annoyance hyperacusis?
Negative reactions to certain sounds, not necessarily loud.
What is phonophobia or fear hyperacusis?
Fear/avoidance of safe levels of sounds.
What are the causes of hyperacusis (8)?
1) Unknown cases (mostly)
2) Main known causes:
̶ - Excessive noise exposure
̶ - Meniere’s disease
̶ - Head injury
3) Other causes:
̶ - Bell’s palsy
̶ - Migraines
̶ - Genetic causes (William syndrome)
̶ - Autism
Normally, in the CNS, loudness is coded by changes in (2)
- Neural electrical activity
- Number of nerve fibers involved
Hyperacusis suggests an abnormal relationship between:
Increased neural activity & The number of neural fibers involved
AND
Increased sound level (dB)
What is happening with hyperacusis?
- The number of nerves that get involved in the sound are more than normal
- The brain has a misjudgement of the sound
- Neural activity increases more rapidly than dB level
What are two assessments for hyperacusis?
1) LDL Test to Measure “Loudness Hyperacusis”
2) Using Hyperacusis Questionnaires
What are some cautions with LDL testing for hyperacusis?
- Caution should be taken to not trigger a hyperacusis episode.
- You may delay LDL testing until the next visit and after building a rapport with the patient.
What are the instructions for LDL testing?
You will listen to different tones. Each tone will be made slightly louder in steps. Tell me when the loudness of the tone would not be OK for more than 2-3 seconds.
What are the 9 steps of LDL testing?
̶1) Use pulsed tones.
̶2) Use a visual analog scale to rate the loudness between 0 (inaudible) to 100 (uncomfortably loud).
̶3) Begin with levels just above the threshold.
̶4) Present each tone for 2 sec.
̶5) Gradually increase levels in 5-dB increments.
̶6) Do not present a signal that produces a rating above 80%.
̶7) Method 1: Test three times at each frequency (500, 1000, 2000, and 4000 Hz), and report the average.
̶8) Method 2: Test two tomes, and record only the second set of LDLs.
̶9) Exclude 8000 Hz, as patients are typically bothered at high frequencies.
What are 4 hyperacusis questionnaires?
1) Hyperacusis Problems Questionnaire (HPG)
2) Hyperacusis intake questionnaire (HIQ)
3) Hyperacusis Disability and Handicap Scale (HDHS)
4) Modified Khalfa Hyperacusis Questionnaire
What do hyperacusis questionnaires aim to do (4)?
- Identify hyperacusis
- Determine its severity and impact
- Measure reactions to sounds
- Use the information for counseling and ST
How does the Hyperacusis Problems Questionnaire (HPG) work?
- An open-ended questionnaire.
- To list the problems because of hyperacusis in
order - Examples of patients’ responses:
̶ - “I refrain from going to restaurants due to noise discomfort”
̶ - “The sound of clanging dishes is painful”.
What does the hyperacusis intake questionnaire (HIQ) gather information about (7)?
It gathers information about:
̶- Hyperacusis duration
̶- Potential causes
̶- Exacerbating or alleviating factors
̶- Type of hyperacusis (e.g., loudness,
annoyance, fear, or pain).
̶- Previous treatments
̶- Associated symptoms like migraines or disturbances in smell and taste
- It could be an ideal case history form (no final score).
When is the hyperacusis disabiity and handicap scale used?
It is often employed before and after therapies.
HDHS - Part 1:
- Aim: To rate “loudness”, ‘annoyance”, “fear”, and “pain” in
exposure to each of the ten sounds listed. - Method: Rating between
- 0 (not loud/annoying/fearful/painful) to
- 100 (unbearably loud/annoying/fearful/painful)
HDHS - Part 2:
- Aim: To compare the impact of “hearing loss”, “tinnitus”, and “hyperacusis” in each of the 10 items listed.
- Method: Rating the level of “agreement” or
“disagreement” with these statements between:- 0 (completely disagree) to
- 100 (completely agree)
Explain the modified khalfa hyperacusis questionnaire
- The HQ consists of 20 items.
- The response choices are:
̶ - No (0 point)
̶ - Yes, a little (1 point)
̶ - Yes, quite a lot (2 points)
̶ - Yes, a lot (3 points) - The overall HQ score ranges from 0 to 42.
- Scores 28 ≥ are considered as strong hypersensitivity to sounds
What is a misophonia questionnaire?
Misophonia Assessment Questionnaire (MAQ; Johnson, 2014)
In MAQ, the severity of symptoms is rated as
- Mild (1–21)
- Moderate (22–42)
- Severe (43–63)
Questionnaires are used for ____ and choosing the ____.
goal-setting, treatment plan
The following are examples of pain hyperacusis:
- “Setting a coffee mug on a wooden table feels like a thumb pressing hard on the broken bone, deep in the ear.”
- “Walking on gravel feels as if I am pressing the gravel into my wounded ears.”
- “The sound of putting on clothing feels like lightly blowing on an open wound.”
- “My ear feels raw and vulnerable to sound as if it were an open wound.”
Is there a cure for hyperacusis?
There is currently no cure for hyperacusis through medications or surgeries.
3 suggested Management options for hyperacusis:
1) Counseling
2) The use of customized musician earplugs with noise-reduction filters
3) Sound therapy
Explain counselling for hyperacusis
̶- Directed instructions/informational counseling about the potential cause of hyperacusis.
̶- This information can be helpful for sound desensitization through ST.
What is a great counselling resource for hyperacusis?
Hyperacusis Activities Treatment
What might people with hyperacusis do to reduce sound intensity?
Many Individuals with hyperacusis wear regular earplugs or earmuffs as a coping mechanism, reducing sound intensity.
Are earplugs/earmuffs recommended for hyperacusis?
- It reduces speech levels &
̶- Negatively impact communication, socialization, and overall QoL.
̶- This avoidance therapy can worsen hyperacusis by exacerbating sound intolerance over time.
Even though earplugs arent recommended, what is?
Hearing Protection, with Musician earplugs, is recommended:
̶- Effective noise reduction.
̶- Preserving high frequencies, necessary for speech perception.
What is the aim of ST?
Improving sound tolerance or sound desensitization
What are the sound choices for ST?
- BBN
̶- Pink noise
̶- Relaxing sounds, e.g.: music or nature sounds
̶- Those producing hyperacusis
Start with lower level of sounds and gradually increase the sound through weeks/months to slowly habituate them to the sound.
What is the method of ST?
- It begins with daily listening to the sounds at a low level.
̶- Duration and level are increased gradually over weeks or months.
̶- There is a transition from recorded sounds to actual sounds.
ST leads to potential improvement in ____ or ____
LDLs, questionnaires
What is the treatment duration for ST?
Varies between 3 months to 2 years.
What are the 5 suggestions of using ST for those with HL accompanied with hyperacusis?
1) Set Maximum Power Output (MPO) Below LDLs
̶ - Verify MPO using REMs.
̶ - Gradually increase MPO over time, weeks or months.
2) Increase the Reaction Time of Automatic Gain Control (AGC) to respond quickly to loud sounds.
3) Enable User Volume Control
4) Suppressing Background Noise with
̶ - Adaptive directional microphones
̶ - Adaptive noise reduction circuits
5) Encourage Regular Hearing Aid Use, at least 8 hours a day.
