Hyperacusis Retraining Therapy

Hyperacusis & Hyperacusis Retraining Therapy

Hyperacusis is a particular form of decreased sound tolerance (DST), with abnormal perception of over or extreme loudness of most everyday soft and moderate environmental sounds and speech. These are not perceived as loud by others. This condition is caused by a collapse of normal auditory system regulatory functions due to neurological and sensory damage and other physical disorders. Hyperacusic reaction depends on the frequency and intensity level of sound
rather than any social or psychological significance to the type of sound it is. The effects of hyperacusis can be mild to severe and, in rare cases, debilitating. (Hyperacusis has been known to cause complete loss of balance, severe ear pain, and seizure-like activity in the brain).

There are two forms of hyperacusis, cochlear and vestibular hyperacusis. In cochlear hyperacusis, patients feel ear discomfort or pain when particular sounds are heard at a certain volume level. Severe emotional reactions may also occur, but these are associated with activation of non- auditory centers controlling emotion and fear in the brain's Limbic System, and are not considered part of the hyperacusis mechanism. The neurological process involved in this latter case is quite different and more diverse in the brain and includes the Limbic System activating when triggered by hyperacusis, effecting emotion and mood. Reaction conditions based on or driven by emotion would be considered misophonia or phonophobia, which are other forms of decreased sound tolerance. In some cases, hyperacusis occurs simultaneously with misophonia and phonophobia, as well as with hearing loss.

In vestibular hyperacusis, exposure to sound can cause falling, loss of balance or postural control, severe vertigo, nausea, loss of consciousness, and mental or physical fatigue. The medical literature sometimes identifies different possible sources of vestibular hyperacusis, including Tullio's syndromes, audiogenic seizure disorder and other conditions. Vestibular hyperacusis occurs less frequently than cochlear hyperacusis. However, both can occur together.

Hyperacusis occurs with tinnitus symptoms in nearly 50% of cases and up to 100% of cases caused by head trauma. In hyperacusis, the neuro-electrical signals generated by sound vibrations to the ear are exaggerated and over-amplified either by dysfunctions within the outer hair cell mechanism within the inner ear itself, and/or the auditory neuronal network beyond the inner ear in the mid-brain. When amplification also occurs in the midbrain, as the nerve signals are sent along towards the higher cortical centers, the effect is called central gain. The result of hyperacusis can be intolerance to daily sounds, inability to tolerate the boost provided by hearing aids, or an inability to tolerate the sound therapy levels used in TRT for tinnitus.

Treatment for cochlear hyperacusis primarily uses a special variation of the Jastreboff Method Tinnitus Retraining Therapy protocols, called Hyperacusis Retraining Therapy. Similar Sound Therapy devices, as in TRT for tinnitus, are often used, but applied in a different specific way. Sometimes Hyperacusis Retraining Therapy must be completed to allow effective treatment for tinnitus symptoms or hearing loss. Therefore, in clinical practice, where significant tinnitus, hyperacusis and hearing loss are all occurring, the correct procedure is to implement a step-by- step sequence of Sound Therapy treatment. Dr. Jastreboff points out that the proper evaluation for the specific form of decreased sound tolerance (DST) present is essential, as failure to treat the specific types of sound tolerance problems can lead to using the wrong or insufficient methods, thus resulting in treatment failure. Many patients have incorrectly self diagnosed their DST condition. Mr. Bartlett, however, accurately identifies these conditions as the result of receiving his training and certification in evaluation and treatment of hyperacusis directly from Dr. Jastreboff, and subsequently applying Dr. Jastreboff's approach for several years.

Hyperacusis can occur as a stand alone symptom and disorder, or simultaneously with tinnitus and hearing loss. It has been demonstrated in both singular auditory disorders and certain more complicated neurological disorders, such as autism, and in certain systemic and autoimmune disorders. As some form of decreased sound tolerance occurs in over 50% of tinnitus cases, it is helpful to see a clinician trained in the evaluation and treatment of all forms of decreased sound tolerance, in addition to tinnitus and hearing loss. Finally, some forms of Sound Therapy devices for tinnitus have not been demonstrated in clinically validated studies or have not received FDA clearance to be of use for hyperacusis as a stand alone disorder or as part of a tinnitus problem.

There are specific auditory tests for hyperacusis and its severity. These are not performed as part of a standardized hearing test, and are generally not offered except by an audiologist specializing in hyperacusis.