How to get through a dentist visit safely

A very common fear among people with hyperacusis is the need to go to the dentist for tooth removal or repair, since the dental drill dentists use for this task reaches between 85 and 95 dB, an intensity that can be problematic for those with moderate to severe hyperacusis. Here are some tips on how to handle this situation so that the impact on our ears is minimal or even negligible.

How to handle an MRI

It is very common that, when faced with hyperacusis symptoms, doctors order an MRI (Magnetic Resonance Imaging) to try to detect a cause that could explain these symptoms. The noise produced by an MRI is very intense, reaching up to 130 dB, and the duration of the scan can last up to an hour and a half, which can cause irreversible damage to the inner ear without proper hearing protection.

How to protect yourself from rapid volume fluctuations

On several websites, hyperacusis is defined as the “loss of the ear’s dynamic range, understood as the auditory system’s ability to handle rapid increases in sound volume.” At first, I didn’t take this definition very seriously because hyperacusis is, above all, a reduction of the maximum tolerable intensity. Clearly, my problem was excessively loud sounds, which previously were no issue and now were intolerable, and I didn’t notice any particular difficulty with rapid volume changes.

However, over time I realized that this definition is incomplete. In hyperacusis, the limitation is not only the maximum tolerable sound intensity but also sudden variations in volume. This means that sounds with an intensity clearly within our comfortable range can still be incomprehensibly difficult to tolerate. For example, a person with hyperacusis might tolerate the noise of a bus at 75–80 dB without difficulty, yet a door slamming at only 65 dB—if heard in a very quiet environment—can leave the ear somewhat sore and more sensitive.

How to cope with the sound of small speakers

When hyperacusis is bilateral, holding the phone receiver close to the ear for a several-minute conversation can be challenging. If the hyperacusis is severe, it may be impossible without causing increased sensitivity, pain, or a relapse. Small speakers (or micro-speakers), such as those in phones, laptops, some TVs, or other electronic devices, are extremely uncomfortable for many people with hyperacusis even at very low volumes.

Pure-tone audiometry

I am going to explain the basic concepts of an audiogram so that beginners can interpret it correctly. For this, I will use an audiogram kindly provided by a user from the APAT forum.

There are different types of hearing tests. I will explain the pure-tone audiometry, which is the most common, as well as the test used to determine the presence of hyperacusis.

Compressed music

One way to treat hyperacusis is through music, either as the tool for conducting sound therapy or as part of sound enrichment. However, for it to be effective, a wide variety of works (and styles) must be listened to, because if we limit ourselves to a small number of pieces, we will not be adequately stimulating the full frequency spectrum.

Progressive Ear Therapy (PET)

Reading messages on the Hyperacusis Network forum, I came across the case of Rob, who, lacking disability benefits in his country (USA) and needing to keep paying bills, was forced to cope with very severe hyperacusis, having to expose himself to numerous sounds that caused him pain and setbacks.

Causes of hyperacusis

The most common cause of hyperacusis is acoustic trauma, either acute (a single exposure to a very intense level) or chronic (sustained exposure over time to high levels). However, there are many causes that can lead to hyperacusis which, as we see in the following table, are not directly related to the inner ear as one might initially think.

Symptoms of hyperacusis

The main symptom of someone suffering from hyperacusis is intolerance to moderate or even mild sounds. Exposure to sounds causes discomfort and pain, and sounds are perceived as louder than they really are. It can occur in one or both ears.

Hyperacusis and Qigong

 Recently, I came across a successful case of recovery from severe hyperacusis and tinnitus that, due to its characteristics, I believe is worth sharing, as it may open a new avenue of treatment and hope for those suffering from this difficult auditory disorder.

How to treat phonophobia

As we saw in the article Misophonia and Phonophobia, the treatment typically used to address these types of auditory disorders is Cognitive-Behavioral Therapy (CBT). This therapy is used to treat problems arising from certain experiences, emotions, and false beliefs, and is based on the association between thought and behavior. Although it is always best to consult a professional for your particular case, some people may manage with the advice to identify, prevent, and treat phonophobia that I will provide below. Although I focus on phonophobia, these same tips can also be useful for treating misophonia, since, as discussed in the aforementioned article, the mechanisms explaining misophonia and phonophobia are identical.

Misophonia and phonophobia

Although I have already briefly explained what misophonia and phonophobia consist of in Basic Concepts of Hyperacusis, the importance of these auditory disorders in conjunction with hyperacusis can be such that it is worth delving deeper into them.

Among the different auditory disorders in which the patient shows sound intolerance, misophonia and phonophobia are those in which, according to Dr. Jonathan Hazell, “the auditory pathways may function normally, but there is a strong abnormal reaction of the limbic system and the autonomic nervous system, to which the auditory system is closely connected.” Thus, unlike hyperacusis or recruitment, where there is a physiological problem, misophonia and phonophobia are psychological disorders caused by previous negative experiences with certain sounds. However, in the case of misophonia, not all cases are attributed to negative experiences with sounds. Some specialists, such as neuroscientist Aage R. Moller, consider that this condition is not learned but innate, and responds to some “physiological anomaly” in the areas of the brain activated by sound processing. On the other hand, audiologist Marsha Johnson points out that there seems to be a genetic component, as often members of the same family share this problem.

The sound level meter on your phone

The sound level meter is the instrument used to measure the intensity of sounds, and it performs that measurement in decibels (dB SPL). Its most widespread use is to measure noise pollution, but for those of us with hyperacusis it can be an excellent tool to more accurately know the noise level to which we are being exposed, or as an indicator of when we should use hearing protection. It is even more useful for those who have developed phonophobia and are afraid even of sounds that cannot cause them any harm, since it provides us with an objective value of intensity that helps to calm the negative response to sound.

Glossary

When talking about hyperacusis, it becomes inevitable to use certain terms related to acoustic physics or simply auditory medicine. For those who are unfamiliar with the meaning of words such as frequency, bandwidth, octave, etc., I will explain here exactly what all those terms mean in order to facilitate the understanding of the articles hosted on this blog.

Hearing Protection

To protect ourselves from loud sounds or sounds above our tolerance level, we can use earplugs or earmuffs. In the case of earplugs, there are several types: foam, silicone, moldable silicone, custom molds, filtered plugs, musicians’ plugs… Each type offers different levels of protection (from 9 dB up to 33 dB or more), with foam and moldable silicone plugs providing the highest protection.

How much has my hyperacusis improved?

This article is essential for the purpose of this website, but for it to have the positive impact I seek, I could not write it until the right moment. That moment is when, after multiple changes in the hyperacusis treatment in search of the correct and optimal formula, I finally achieved a significant and stable improvement in my sound tolerance, allowing me to perform most activities a healthy person can do without hearing protection.

Hyperacusis Treatment

From the perspective of Western medicine, the best current way to treat hyperacusis (once other options have been ruled out depending on its cause) is through auditory desensitization therapies, which retrain the brain not to interpret sounds as loud, annoying, and/or painful when they are not for a healthy person. This treatment works thanks to brain plasticity, that is, the brain’s ability to form new neural networks based on the external stimuli it receives.

Basic concepts of hyperacusis

Hyperacusis is an auditory disorder in which sounds are perceived as louder than they really are and/or the pain threshold is reduced to levels that affect daily life. Everyday sounds such as clinking dishes, children screaming, dog barking, crumpling plastic bags, the sound of small speakers like those of a mobile phone or laptop, vehicle traffic noise, or even the human voice become intolerable.