Hyperacusis is an increased sensitivity to sounds that other people perceive as having normal intensity. It is observed in injuries, diseases of the labyrinth, neuritis, migraines, multiple sclerosis, amaurotic idiocy, meningitis, and a number of other pathologies. It is diagnosed on the basis of complaints, the results of otolaryngological and neurological examinations, additional studies. Treatment is carried out by drug therapy, physiotherapy. Sometimes blockades are carried out, operations are carried out.
Hyperacusis is called a decrease in tolerance to sounds of normal volume. The violation is characterized by painful sensitivity, inappropriate or exaggerated reactions to sounds that others regard as ordinary (not threatening, not too loud).
Hyperacusis is a broader concept than phonophobia (pathological fear of sounds) or misophonia (a feeling of dislike towards sounds), which suggest the presence of negative emotional associations. It includes both the listed disorders and disorders in which sounds are painfully perceived regardless of the psychological state.
Why hyperacusis occurs
Defeats of the maze
There are the following diseases of the inner ear that cause hyperacusis:
- Meniere’s disease. There is an extremely intense systemic dizziness of a paroxysmal nature. During seizures, nausea, vomiting, impaired coordination, noise and congestion in the ear, palpitations, shortness of breath occur. The duration of the episode varies from a few minutes to several days, more often it is 2-8 hours.
- Perilymphatic fistula. The communication between the inner and middle ear is formed against the background of injuries, otitis media, intracranial hypertension. It is manifested by dizziness, noises, a feeling of stuffiness of the ear. Hyperacusis is caused by an increase in symptoms with sufficiently loud sounds. Manifestations also increase with coughing, sneezing, changes in atmospheric pressure.
- Otosclerosis. Accompanied by loss of stirrup mobility, conductive and sensorineural hearing loss. Women suffer more often. The disease is asymptomatic for some time, then the perception of low tones suffers with possible hypersensitivity to high ones, which is manifested, for example, by a poor understanding of male speech with hyperacusis during a conversation with a woman or a child. In the future, the perception of high-pitched sounds also worsens.
A possible cause of the symptom is acoustic trauma. In the acute form, there is severe pain, sudden hearing loss in combination with dizziness, squeaking, ringing in the ears. Hyperacusis may form during the recovery period. With a chronic course, the disorder is expressed at the stage of initial manifestations, subsequently replaced by hearing loss and tinnitus.
Post-concussion syndrome is considered a frequent complication of traumatic brain injuries. It is most common in concussions. Dizziness, persistent cephalgia, hyperacusis, insomnia, night awakenings, anxiety, fatigue, mood decline, emotional instability are possible. There is a slight deterioration in cognitive abilities – memory, concentration of attention.
Diseases of the cranial nerves
A common neurological cause of hyperacusis is neuritis of the facial nerve. It is formed after hypothermia, viral infections, otitis media, injuries. It is characterized by facial asymmetry, weakness of facial muscles and partial loss of taste sensations on the affected side. Ramsey Hunt syndrome is provoked by the herpes virus. There are general hyperthermia, rashes on the ear, tongue and soft palate, indistinct paresis of the facial muscles on the diseased side, hyperacusis, prosopalgia.
The disease is manifested by paroxysmal cephalgia, spreading to one half of the head (most often the right). Periodic changes of sides are possible. Hyperacusis in the phonophobia variant accompanies all forms of migraine: simple, with aura, menstrual, etc. The symptom is especially pronounced with migraine status – an attack lasting more than 3 days. It may accompany a migraine stroke, which, along with hemicrania, is characterized by neurological disorders that persist for a week or more.
Typical manifestations of various forms of meningitis are hyperthermia, intoxication syndrome, excruciating bursting headaches, increased muscle tone, painful reaction to any stimuli: light, noise, touch. Hyperacusis is detected in the following types of leptomeningitis and pachymeningitis:
- Bacterial: pneumococcal, meningococcal, tuberculosis, Lyme disease.
- Viral: enterovirus, acute lymphocytic and others.
- Fungal and protozoal: candidiasis, toxoplasmosis, malaria.
Non-communicable neurological diseases
The symptom is often found in multiple sclerosis. Early signs of pathology are weakness in the legs, radicular pain, optic neuritis, nystagmus. Subsequently, spastic paraparesis or tetraparesis, ataxia, intentional tremor, chanted speech develop. Hyperacusis is also characteristic of an early form of amaurotic idiocy – Tay-Sachs syndrome. It occurs at the initial stage, and is further supplemented by a decrease in motor activity, vegetative disorders, muscle hypotension, bulbar syndrome.
In patients with post-traumatic stress disorder, hyperacusis has a pronounced emotional component. Sounds are perceived as unexpected, frightening, signaling danger. Hypersensitivity to any stimuli is noted against the background of psychoemotional exhaustion. There are flashbacks, insomnia, aggressiveness, emotional lability, unpleasant somatic sensations.
In depression, hyperacusis is formed against the background of emotional instability, increased exhaustion. It is more common in patients suffering from neurotic depression with a pronounced anxiety component. Other signs are a steady decline in mood, painful insensitivity, slowing down of speech, movements and thinking. Possible thoughts of suicide.
In case of suspected diseases of the labyrinth, diagnostic measures are carried out by an otolaryngologist and a vestibulologist. Patients with neuritis, meningitis and other neurological pathologies are examined by a neurologist. In case of mental disorders, a consultation with a psychiatrist or a psychotherapist is indicated. During the survey, they find out the time of the appearance of hyperacusis, its connection with external factors, and other symptoms.
In migraine, it is of high importance to establish the nature of cephalgia. When collecting anamnesis, the presence of chronic otitis media, TBI, diseases accompanied by increased intracranial pressure is clarified. When diagnosing acoustic injuries in the history of life, an episodic or permanent stay in conditions of increased noise is detected. To clarify the diagnosis, such procedures are prescribed as:
- Otoscopy and microtoscopy. For Meniere’s disease, the changes are uncharacteristic. Acute acoustic injuries are accompanied by rupture, chronic – retraction of the eardrum. With perilymphatic fistulas, edema and hyperemia of the membrane are noted, the light reflex is weakened. With otosclerosis, the Hombgren triad is determined, a local decrease in skin sensitivity, sometimes atrophy or hypertrophy of the membrane.
- Neurological examination. There are no neurological disorders in post-concussion trauma, there is vegetative dysfunction. With neuritis, muscle weakness and sensitivity disorders of half of the face are detected. With meningitis, meningeal symptoms are detected, with migraine stroke and multiple sclerosis – a characteristic neurological deficit.
- Studies of the auditory analyzer. Recommended for pathologies of the labyrinth and acoustic injuries. The list of techniques may include tuning fork examination, speech and tonal threshold audiometry, otoacoustic emission, electrocochleography, acoustic impedance measurement. The scope of the examination is determined depending on the nature of the violation.
- Studies of the vestibular apparatus. Necessary when involving a maze. Vestibulometry, computer stabilography, indirect otolithometry are prescribed. Hypo- or hyperreflexia may be characteristic of various diseases. In Meniere’s disease, these conditions change each other depending on the time of the examination (paroxysm or intercrime period).
- Other hardware techniques. As part of the examination, X-rays of the temporal bone, CT and brain MRI can be performed. A number of patients are shown electroencephalography and echoencephalography, extra- and transcranial Dopplerography, duplex scanning. In neurological pathologies, electromyography, electroneurography, and the study of evoked potentials are prescribed.
- Spinal puncture. It is the main method of diagnosing meningitis, allows you to verify or refute this diagnosis. The liquid flows out under pressure, transparent in serous processes, cloudy in purulent processes. According to the results of the analysis, pleocytosis, an increase in protein levels, and sometimes a decrease in the amount of glucose are determined.
- Laboratory tests. With ganglionitis of the cranial node, the herpes zoster virus is detected by ELISA or PCR, an immunogram is prescribed to detect a possible secondary immunodeficiency. With amaurotic idiocy, a sharp decrease in the level of gescominidase A is detected in the biochemical blood analysis, and signs of cell degeneration are detected according to the results of neuron microscopy.
In the diagnosis of migraine, the characteristic clinical picture plays a decisive role, the absence of changes according to additional studies. Patients with post-comm syndrome, PTSD and depression are shown psychological testing to assess personal characteristics, emotional-volitional and cognitive spheres, to identify characteristic signs of mental disorders.
Therapeutic tactics for hyperacusis are determined taking into account the cause of the pathology:
- Defeats of the maze. As part of the long-term therapy of Meniere’s disease, agents for stimulating microcirculation, venotonics, diuretics, neuroprotectors are used. Paroxysms are stopped with the help of neuroleptics, antihistamines, vasodilators and diuretics. Vestibular apparatus training is recommended. With perilymphatic fistulas, antispasmodics, disaggregants, multivitamins are used.
- Traumatic injuries. Chronic acoustic trauma is considered an indication for a change of profession. Antihypoxants, nootropics, group B vitamins are useful. Darsonvalization and hyperbaric oxygenation are effective. With postcommotion syndrome, vegetostabilizers, antispasmodics, nootropics, neurometabolites, psychological correction are required.
- Neuritis. With Bell’s syndrome, treatment of the underlying disease is carried out against the background of other pathologies. At the initial stage, medications with vasodilating and decongestant action, glucocorticoids are prescribed. Subsequently, physiotherapy, physical therapy, massage are used. Patients with ganglionitis in the acute period are shown antiviral agents, immunotherapy, subsequently – anticonvulsants, anticholinesterase and sedatives, medications to improve microcirculation, reflexotherapy.
- Migraine. Relief of paroxysms is carried out using combined analgesics, codeine-containing agents. With prolonged retention of symptoms, triptans are prescribed. Migraine status is an indication for the administration of glucocorticoids and ergot preparations, antiemetic and psychotropic pharmaceuticals, intraosseous and periosteal blockades.
- Meningitis. Hospitalization is being carried out. With purulent processes, antibiotics and sulfonamides are required. With tuberculous meningitis, continuous administration of two or three antibacterial agents is necessary. In viral meningitis, general restorative and symptomatic medications are used, in severe cases, diuretics and corticosteroids are added to the scheme.
- Multiple sclerosis. In case of exacerbations, pulse therapy with glucocorticoids is performed, plasmapheresis can be used. Immunomodulators and immunosuppressors are recommended to stabilize the condition and prevent progression. Symptoms are eliminated with the help of stimulants, antidepressants, barbiturates, beta-blockers, anticonvulsants.
Patients with hyperacusis undergo the following surgical interventions:
- Meniere’s disease: decompression operations (drainage of the endolymphatic sac, fenestration of the semicircular canal, perforation of the base of the stirrup), laser destruction of the labyrinth, cervical sympathectomy.
- Perilymphatic fistula: tympanotomy, atticoanthromastoidotomy.
- Otosclerosis: stapedoplasty, fenestration of the labyrinth, mobilization of the stirrup.
- Bell’s palsy: nerve stitching or neurolysis in case of traumatic injury, nerve trunk plastic surgery using branches of a healthy facial nerve on the opposite side.