Introduction
Those who suffer from hyperacusis have an increased sensitivity to sound, which makes normal noises like running water seem very loud. Daily tasks in typical environments, like household chores or duties at work, may become challenging as a result. They might try to avoid situations in which they may be exposed to noise and experience anxiety, stress, or social isolation. Adults with hyperacusis comprise 8 to 15 % of the population. A lot of people with tinnitus, or ringing in the ears, are also affected by this condition.
Hyperacusis is a condition with a low tolerance for sound in one or both ears. It is also referred to as increased sensitivity to sound. The condition alters how loudness is perceived by one. Normal sounds, like car engines, seem incredibly loud. They may occasionally feel that their own voice is too loud. The perception of excessive loudness may lead to pain and irritation, resulting in increased stress levels. Being in public places like work or school might also be challenging. This may result in isolation, social exclusion, aversion to loud noises (phonophobia), and depression.
There are two main types of hyperacusis:
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Damage to the cochlea, the body's sound-sensing organ, causes cochlear hyperacusis, which makes the brain more sensitive to certain pitches of sound;
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Vestibular hyperacusis is a condition that also affects the vestibular (balance) system of the body.
What Is Vestibular Hyperacusis?
Vestibular hyperacusis affects the body's balance and results in nausea, vertigo, and a sense of falling, in addition to hearing loss and sound hypersensitivity.
When a person has vestibular hyperacusis, exposure to sound can make them fall or lose control of their balance or posture. Several names exist for this condition, including Tullio's syndrome and audiogenic seizure disorder. Some of the same reactions as cochlear hyperacusis can also occur with sudden, severe vertigo or nausea. In addition, vestibular hyperacusis can occasionally interfere with the autonomic nervous system and result in issues like unconsciousness, mental confusion, nausea, or extreme exhaustion.
What Causes Vestibular Hyperacusis?
A hole or thinning in the temporal bone that covers one of the semicircular canals is where vestibular hyperacusis develops. The mechanism by which the sound waves could stimulate nerve signals in areas of the inner ear that typically only respond to motion was a mystery until very recently. It is now known that the fluid (endolymph) within the semicircular canals can pump abnormally due to sound waves entering the inner ear through a tiny hole in the temporal bone. The waves that pass through the canals stimulate the hair cells, which then communicate information about the head movement to the brain. The brain misinterprets this information as a head rotation. The eyes receive signals from the brain in response.
They compensate for it by rotating the other way. The result is a momentary feeling of spinning and nystagmus. A congenital (present from birth) issue with the inner ear's development, certain infectious diseases, and trauma can all cause an opening in the temporal bone.
Most vestibular hyperacusis is associated with semicircular canal dehiscence syndrome (SCDS). When exposed to loud noises, 90 % of people with SCDS, as determined by CT (computed tomography) scanning of the temporal bones, experience symptoms.
Vestibular hyperacusis is also linked to other conditions such as:
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Otosclerosis.
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Congenital syphilis.
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Ménière's disease.
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Perilymph fistula.
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Cholesteatoma with fenestration and semicircular canal erosion.
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Head trauma.
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Post stapedectomy.
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Post tympanomastoidectomy.
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Collapsed canal syndrome.
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Congenital (present from birth) deafness.
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Middle ear osteoma (non-cancerous tumor).
What Are the Symptoms of Vestibular Hyperacusis?
One or both ears may be affected by hyperacusis, which can lead to pain or discomfort in the neck, jaw, or ears. The condition may also cause emotional distress in those who have it.
Additional symptoms of hyperacusis include the following:
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Vertigo (sensation of motion).
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Nausea.
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Imbalance.
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Nystagmus (rapid uncontrolled eye movements).
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Insomnia (difficulty sleeping).
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Having trouble concentrating.
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Inability to carry out work duties.
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Issues in relationships.
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Anxiety.
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Depression.
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Social exclusion.
It is important to note that phonophobia, or the phobia of loud noises, is distinct from hyperacusis. Sounds are heard differently if a person has hyperacusis. A psychological disorder called phonophobia involves an emotional reaction to sounds. It has nothing to do with hearing problems. However, due to the perceived over loudness of some sounds, phonophobia can cause hyperacusis, so the two conditions may coexist.
How Is Vestibular Hyperacusis Diagnosed?
Through a careful examination and a review of the patient's medical history, an otolaryngologist (ENT specialist) can frequently identify vestibular hyperacusis. An audiologist will inquire about a patient's symptoms and medical background to start the diagnostic process. Then a physical examination is conducted to look for ear damage and perhaps a hearing test to ascertain a person's capacity for hearing sounds of different frequencies. A high-resolution scan of the temporal bones can be used to confirm this to check for any holes, thinning, or other ear issues.
How Is Vestibular Hyperacusis Treated?
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Simple lifestyle modifications, like wearing earplugs, are part of the treatment for less severe cases of vestibular hyperacusis. In addition, some patients might be given the option of surgery.
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Comprehensive diagnostic testing should be carried out in otology, neurology, and audiology offices for people who complain of losing their balance when exposed to sound.
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Creative testing protocols might be developed to elicit or produce a response in a clinical setting. In the clinic, a tone at 500 Hz that is gradually increased can frequently cause vestibular hyperacusis.
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Clinicians should present tests that are specifically designed for each patient's situation. For instance, if someone reports falling when large vehicles pass by, it may be necessary to modify a test to include lower-frequency tones at very low volume levels, narrow-band noise, or even white noise to pinpoint the precise problem area. With a computerized dynamic posturography test, a portable audiometer could be used to present different sounds to elicit a balanced response.
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Another option is to present sound stimulation using electroencephalography (EEG) and an audiometer to observe changes in brain-wave patterns in response to sound.
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The ineffectiveness of the other therapies may necessitate "round and oval window reinforcement" surgery for hyperacusis. The tissue behind the ear is moved around the hearing bones during the procedure. In addition to strengthening the bones, this also lessens sound sensitivity.
Conclusion
Every day, sounds like running water becomes excessively loud when one has hyperacusis. It might feel unpleasant or even painful and cause vertigo, nausea, and a sense of falling. If normal noises seem louder than usual, a doctor must be consulted. Lifestyle modifications such as using earplugs or acoustic therapies can be beneficial to some patients.
