![]() Hyperacusis can be managed most effectively by using noise generators alongside a programme that aimed at reducing the fear and anxiety associated with sound exposure. Research in the 1980s (Hazell & Sheldrake 1991) showed that the use of wide band noise applied to the ear by wearable sound generators can help in the treatment of abnormal hypersensitivity of hearing. When these sounds are heard in the absence of plugs, their perceived loudness is greatly increased. This is actually making things worse, as it encourages further increase in the amplification of sounds on their way to the auditory (hearing) cortex. When hyperacusis develops there is a great temptation to plug the ear to exclude unwelcome sounds. Some people take to wearing ear plugs, perhaps at night, to avoid sounds becoming intrusive, and this simply worsens the sensitivity. External sounds may then increase dramatically in their perceived intensity and intrusiveness. The auditory filters ‘open’ in an attempt to monitor the external sound environment. ![]() This process is enhanced by silence which is considered to be one of the signs of possible predator activity. The brain is always looking for the best way it can for auditory signals. The absence of sound stimulation leads to an increase in auditory gain (amplification) in the subconscious auditory pathways. However complete silence is not found in nature, and should be considered ‘unnatural’. Many people seek silence as a way to escape from the pressures of everyday life. In practice, most people with decreased sound tolerance have both hyperacusis and phonophobia/misophonia together in varying proportions. In treating these conditions, it is important to diagnose which condition is present and which is dominant. Often normal environmental sounds like traffic, kitchen sounds, doors closing, or even loud speech, cannot be tolerated. Phonophobia - if the dislike of certain sounds is very strong we may call it ‘phonophobia’ literally - fear of sound. Sometimes because of the belief that it will damage the ear it makes symptoms (sensitivity, or tinnitus) worse. Misophonia can lead to hyperacusis (changes in central auditory processing) and a consequent persistence of abnormal loudness perception. The auditory pathways may be functioning normally, but there is an abnormally strong reaction of the limbic (emotional system) and autonomic nervous system (body control system) to which the auditory system is intimately connected. ![]() Misophonia is the intense dislike of being exposed to a certain sound. Hyperacusis is due to an alteration in the central processing of sound in the auditory pathways where there is an abnormally strong reaction from exposure to moderate sound levels. Hyperacusis is the medical term used to describe the abnormal discomfort of everyday sounds that some people experience. There are different components which can contribute to sensitive hearing such as hyperacusis, misophonia and phonophobia. This can occur in both people who have a hearing loss as well as those who don't. Some people have especially sensitive hearing and are unable to tolerate ordinary levels of noise.
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