Cochlear Hyperacusis - Causes, Types, Diagnosis, and Treatment

What Is Hyperacusis?

Hyperacusis is an abnormal condition characterized by an increased sensitivity to ordinary sounds. As a result, there is associated pain and discomfort. The degree of hyperacusis can range from mild pain associated with discomfort to severe pain with difficulty maintaining a regular upright posture or a complete loss of balance.

What Are the Types of Hyperacusis?

Hyperacusis is of two types, namely,

• Cochlear hyperacusis

• Vestibular hyperacusis.

What Is Vestibular Hyperacusis?

There is balance loss or postural control loss in vestibular hyperacusis, and the individual feels like he is about to fall when sound exposure occurs. It is associated with severe nausea, vertigo, mental confusion, loss of consciousness, and fatigue. It is also called audiogenic seizure disorder and Tullio's syndrome.

What Is a Cochlear Hyperacusis?

It is the most common form of hyperacusis. Ear pain, discomfort, irritation, and annoyance are seen with sound exposure in cochlear hyperacusis. Even exposure to soft sounds brings about these symptoms. Most people with cochlear hyperacusis tend to leave the room or cover their ears when exposed to sounds.

Emotional reactions, panic attacks, and crying are commonly associated with cochlear hyperacusis. As a result of cochlear hyperacusis, the affected individuals feel something wrong is happening around them, causing dissociation from reality or confusion. Headache is a common feature of both cochlear and vestibular hyperacusis.

What Is the Pathophysiology of Cochlear Hyperacusis?

Cochlear hyperacusis is caused by damage to the impulse conduction pathway. The regulatory mechanism for amplifying sounds is responsible for reducing the sounds and noises heard. In the case of cochlear hyperacusis, the amplification regulator is affected so that it magnifies the sounds and noises. Also, damage to the middle ear bones needed for transmitting and amplifying sounds can cause cochlear hyperacusis. In some cases, a brain-chemistry dysfunction can bring about cochlear hyperacusis.

What Are the Signs and Symptoms of Cochlear Hyperacusis?

• People with Cochlear Hyperacusis are unable to tolerate (decreased tolerance).

• Sensitive to the sounds in the environment.

• Experience pain in hearing sounds.

• They may feel fear sometimes when hearing the sound.

• Fullness of ear (heavy in the ear).

• Difficulty in balancing equilibrium in the ear.

• Depression.

• Anxiety.

• Ringing in the ears.

• It sounds like crying babies can feel annoying and disturbed.

• Normal sounds become irritating.

What Causes Cochlear Hyperacusis?

Cochlear hyperacusis has no gender or age predisposition and can occur in everyone. It is not a congenital condition.

Of the many causes of cochlear hyperacusis, the following are some common causes:

• Trauma to the head.

• Frequent ear infections.

• Surgeries of the ear or brain.

• Addison's disease.

• Exposure to toxins and medications that cause damage to the ear.

• Meniere's disease.

• Post-traumatic stress disorder.

• Persistent exposure to loud noises, which damages the cochlea.

• Tay-Sachs disease.

• Lyme disease.

• William's syndrome.

• Migraines.

• Autism.

• Multiple sclerosis.

• TMJ disorders.

• Cerebral palsy.

How Is Cochlear Hyperacusis Diagnosed?

An Otolaryngologist or audiologist identifies the type of hyperacusis and severity of the disease.

The following tests help in the diagnosis of cochlear hyperacusis:

1. Loudness Discomfort Level Test:

This test measures the level of loudness that causes discomfort and helps categorize the level of hyperacusis.

2. Audiogram or Hearing Test:

It is a hearing test that measures the ability of the patient to hear sounds of different pitches and frequencies. With the help of an audiometer, the person's sensitivity to different sound frequencies is measured. However, before performing the hearing test, that particular patient's loudness and discomfort level must be measured so as not to expose the patient to a higher frequency of sounds.

What Is the Treatment for Cochlear Hyperacusis?

Treatment for cochlear hyperacusis is based chiefly on treating the causes, and there is no medical or surgical treatment, in particular, to treat cochlear hyperacusis. Regarding cochlear hyperacusis, Tinnitus retraining therapy is the most preferred treatment choice.

1) Tinnitus Retraining Therapy (TRT):

TRT involves two therapies, namely counseling and sound therapy. In tinnitus retraining therapy, the patient is trained to adapt to the excessive sounds caused by hyperacusis. It is a form of habituation-oriented therapy. As a result of this therapy, the patient gets acquainted with the sounds and becomes less reactive to the hyperacusis sounds. Before starting sound therapy, the patient's loudness and discomfort levels are measured. In sound therapy, the sensitivity of the patient to sounds is reduced. As a result, the perspective of how a person views sound is altered, and they tend to take it more positively. In addition to tinnitus retraining therapy, psychological therapies like counseling and cognitive behavior therapies also prove to be helpful in patients with cochlear hyperacusis.

2) Counseling:

It is done to prepare the patient mentally to accept hyperacusis. In this, the patient is explained about the anatomy and physiology of the ear, how sounds are transmitted, and how hyperacusis occurs. Thus, giving an insight into hyperacusis and freeing the patient of their fears and problems caused by it.

3) Cognitive Behavior Therapy:

Cognitive behavior therapy helps the patient come out of the symptoms of cochlear hyperacusis, change their behavior of avoiding noises, and manage stress caused by loud sounds.

What Lifestyle Changes Help in Cochlear Hyperacusis?

• Do not try to avoid noisy situations.

• Avoid using earplugs or muffs all the time. It can increase hyperacusis severity by raising the brain's sensitivity to sounds.

• Do try some relaxation techniques like yoga, deep breathing, etc.

• Listen to soft sounds and music.

How Can We Prevent Cochlear Hyperacusis?

Hyperacusis can be prevented before its occurrence in the following ways:

• Avoid exposure to loud noises for an extended period, especially sounds above 85 decibels.

• While working in places with heavy machinery that produces excessive sounds, wear ear protective aids.

• Listen to music in earphones only at reduced volume and for shorter periods.

Conclusion:

Although not a curable condition, cochlear hyperacusis can best be managed by following adequate measures. First, do not be stressed; try to adapt people to these sounds. This can make their lives easier. Also, when they experience any discomfort or anxiety, reach out to a healthcare provider and get psychological counseling, which can help them come out of the situation.