Do You Think Normal Sounds Are Loud, Painful, or Annoying?
Around the holidays, it’s fun to spend time with family and friends. However, multiple sclerosis may make it more challenging to enjoying that fun. This year my husband and I are staying home rather than traveling several states away to visit family. That means we will not be spending time with my brother and his wonderful family of six.
Although I’m sad to not get to meet my new niece (do you think she would stop growing if I asked her nicely?), I’m somewhat relieved that I will not have to fight the overwhelming urge to clasp my hands over my ears, run into another room, and isolate myself from the joyous laughter and inevitable rough-housing of three beautiful nephews.
Why is it difficult to be around all of the excitement?
Well, it’s because I am overly sensitive to noises that have the power to cause sharp physical pain. A pain that feels somewhat like I imagine an icepick hammered through the ear into the brain might feel. A pain that literally makes my body twitch and jerk ever so subtly.
Matt recently discussed how loud sounds causes his startle reflex to move into overdrive which he referred to as myoclonus. My reaction of sudden, but brief, pain to loud sounds is somewhat different. What I experience is called hyperacusis.
Hyperacusis is commonly defined as a heightened, abnormal sensitivity or intolerance to ordinary, everyday sounds that would not bother most people. That means what may sound normal and completely acceptable to you may be perceived as outrageously LOUD and painful to me. People who experience hyperacusis (about 8-15 percent of the general population) often also have tinnitus (ringing in the ears).
Hyperacusis affects people to varying degrees, from mild to severe, and is different than phonophobia (fear of sound) or misophonia (dislike of sound) which usually involve emotional response to specific sounds. People with hearing loss who experience loudness recruitment (an abnormal growth in the perception of loudness) may also experience hyperacusis, but not always.
Although hyperacusis has many known causes and associations, most cases have no known cause. A few diseases and syndromes that are associated with hyperacusis, include migraine, depression, post-traumatic stress disorder, head injury, Lyme disease, Williams syndrome, fibromyalgia, Addison’s disease, autism, myasthenia gravis, and middle cerebral aneurysm. Research suggests that hyperacusis may also be associated with multiple sclerosis.
Not all hyperacusis is the same
A recent literature review suggests that there are four forms of hyperacusis – loudness, annoyance, fear, and pain – which distinguish between these general perceptions and associated reactions to ‘loud’ sounds. People with hyperacusis may experience one of these reactions or a combination.1
- Loudness hyperacusis – moderately intense sounds are judged to be very loud compared with what a person with normal hearing would perceive. It is possible that only some sounds, some tonal frequencies, or even one ear might result in loudness hyperacusis.
- Annoyance hyperacusis – a negative emotional reaction to sounds which may be specific to particular sounds or groups of sounds. The annoyance may manifest as irritation, anxiety, or tension.
- Fear hyperacusis – an aversive response to sounds that results in an anticipatory response and avoidance behavior, often impairing one’s ability to enjoy normal social, recreational, or vocational activities.
- Pain hyperacusis – pain is experienced at much lower sound levels than listeners with normal hearing, and may be reported, for example, as a stabbing pain in the ear or the head. It is not clear whether pain hyperacusis reflects a lowering of the normal pain threshold (typically around 120 decibels) or a different process or mechanism altogether.
I find it interesting that several studies have reported hyperacusis among musicians, an occupation which also increases the risk of developing tinnitus. In a case study, researchers speculated that demyelination in the pons area of the brain or in central auditory pathways could be the cause of hyperacusis in patients with MS.2 Hyperacusis warrants more research.
- Tyler RS, Pienkowski M, et al. A review of hyperacusis and future directions: part I. Definitions and manifestations. Am J Audiol. 2014 Dec;23(4):402-19.
- Weber H, Pfadenhauer K, Stöhr M, Rösler A. Central hyperacusis with phonophobia in multiple sclerosis. Mult Scler. 2002 Dec;8(6):505-9.