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ULY CLINIC
ULY CLINIC
25 Septemba 2025, 01:19:10
Hyperacusis
Hyperacusis is abnormally heightened sensitivity to everyday sounds, resulting in discomfort or pain at normal auditory levels. It reflects increased irritability of the auditory neural pathway and an unusually low hearing threshold.
Pathophysiology
Auditory neural hypersensitivity: Dysfunction or hyperactivity in the cochlea, auditory nerve, or central auditory pathways.
Peripheral causes: Damage to outer hair cells in the cochlea may lead to altered sound amplification.
Central causes: Dysfunction in the auditory cortex or brainstem inhibitory circuits can amplify perception of normal sounds.
Associated conditions:
Noise-induced hearing loss
Migraine and vestibular disorders
Bell’s palsy and cranial nerve lesions
Psychiatric conditions such as anxiety and post-traumatic stress disorder
Examination Technique
Patient positioning: Seat the patient in a quiet room.
History: Ask about sensitivity to specific sounds, duration, triggers, and associated discomfort.
Audiologic testing:
Pure tone audiometry to determine hearing threshold.
Loudness discomfort level (LDL) testing to quantify hyperacusis.
Observation: Note behavioral reactions to everyday sounds during examination.
Documentation: Record severity, affected frequencies, and impact on daily activities.
Clinical Features
Feature | Manifestation |
Hearing sensitivity | Sounds perceived as abnormally loud or painful |
Discomfort | Ear pain, tinnitus, headache, or anxiety in response to normal sounds |
Onset | Can be sudden (e.g., after trauma) or gradual |
Associated findings | Tinnitus, ear fullness, migraine, anxiety |
Differential Diagnosis
Condition | Key Feature | Notes |
Noise-induced hearing loss | Hyperacusis with hearing threshold shift | Usually high-frequency loss, history of noise exposure |
Migraine-associated hyperacusis | Sound sensitivity with headache or photophobia | Often episodic |
Bell’s palsy / facial nerve lesion | Unilateral hyperacusis | Due to stapedius muscle paralysis |
Anxiety / PTSD | Sound sensitivity with emotional triggers | Central amplification of auditory input |
Otosclerosis / cochlear disorders | Abnormal loudness perception | Usually with conductive or mixed hearing loss |
Pediatric considerations
Children may describe discomfort as “loud” or “hurting my ears.”
Behavioral observation is important, especially in nonverbal children.
Can affect concentration, learning, and social interactions.
Geriatric considerations
Often associated with presbycusis or age-related auditory neural changes.
May exacerbate tinnitus or hearing aid intolerance.
Limitations
Subjective symptom; requires patient cooperation and clear history.
Audiometric thresholds may be normal; specialized tests may be needed.
Differentiation from phonophobia or misophonia requires careful evaluation.
Patient counseling
Explain the nature of auditory hypersensitivity and potential triggers.
Advise sound therapy or gradual desensitization in chronic cases.
Discuss management of associated conditions (e.g., tinnitus, migraine, anxiety).
Recommend hearing protection in noisy environments while avoiding auditory deprivation.
Conclusion
Hyperacusis is an abnormal increase in hearing sensitivity due to heightened auditory neural excitability. Early recognition, audiologic assessment, and management of underlying causes or contributing factors can reduce discomfort, prevent hearing-related complications, and improve quality of life.
References
Baguley DM, et al. Hyperacusis: Pathophysiology and Clinical Management. Lancet. 2013;382(9906):1015–1025.
Tyler RS, et al. Hyperacusis: Clinical and Research Perspectives. Otolaryngol Clin North Am. 2015;48:273–288.
National Institute on Deafness and Other Communication Disorders (NIDCD). Hyperacusis. 2020.
Stach BA. Clinical Audiology: An Introduction. 4th ed. New York: Thieme; 2015.