Tinnitus, Hyperacusis, Misophonia and Phonophobia…what’s the buzz?

Tinnitus can be defined as a noise heard in the ears or head that is not externally produced.  People who experience tinnitus describe it in numerous ways, commonly as a ring, roar, hiss, chirping, etc.  Tinnitus is most often subjective, but a very small part of the population has tinnitus that others can hear.  Tinnitus can be very effectively treated using sound therapies such as Tinnitus Retraining Therapy (TRT), Neuromonics Tinnitus Treatment or masking.  These treatments include the use of sound (broad band noise and/or music), patient education and counseling.

Often along with tinnitus, people can experience hyperacusis.  It is estimated that 40% of tinnitus patients also report hyperacusis to some degree.  So what IS hyperacusis?  Simply defined, it is a decreased tolerance for loud sounds.  Everyone has a threshold for comfort; most people will report sounds being uncomfortably loud when they get to the 95-100 decibel (dB) range.  People with hyperacusis report loudness discomfort levels (LDLs) 70 dB or below.  Hyperacusis is related to the loudness of sounds in general and is not specific to a certain pitch or sound.

What causes hyperacusis?  It can occur for a number of reasons.  A common cause is exposure to a very loud noise, for example, a gunshot or airbag deployment.  Some medications can cause sound sensitivity as well as some medical conditions, such as Lyme Disease or Meniere’s Disease.  It can be congenital or acquired.  Treatments for hyperacusis often involve the use of a neutral sound (broadband noise, pink noise or music) at low levels and include Tinnitus Retraining Therapy and (if tinnitus is also involved) Neuromonics Tinnitus Treatment.  By listening to a specific noise at soft levels for a disciplined period of time each day, patients can increase their tolerances to sound. 

Another sound sensitivity issue is Misophonia, also known as Selective Sound Sensitivity Syndrome (4S).  This may be defined as an intense dislike of a sound or group of sounds.  It should not be confused with hyperacusis.  People with misophonia will typically have normal LDLs, but will have a very strong negative emotional reaction to one sound, for example, gum chewing.  There is often a trigger person, for example, the chewing of one person is more bothersome than of another.  Age of onset is often before age 20.  Of note, it is not uncommon for multiple individuals in a family to have misophonia.  Treatment of misophonia using low level noise can be effective, however, there is no specific treatment protocol widely accepted for misophonia today and there are no standard assessment tools available at this time.  Misophonia treatment may include the inclusion of other health professionals (cognitive therapist, primary care physicians and mental health professionals).

Misophonia should also not be confused with Phonophobia, which is a fear of sound.  Phonophobia often is found in conjunction with hyperacusis.  It may be that the underlying decreased tolerance to sound evokes an overall fear of sounds in general.  It can be very effectively treated in a relatively short period of time.  Treatment involves counseling with regard to cognitive distortions, patient education as well as the use of sound.

For additional information, call our Marietta office for a consultation.

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