Sound Tolerance – When Sound Hurts

Sound Tolerance is a general term used to when someone find themselves sensitive or experience physical discomfort to sounds that others feel are OK.

There are 5 Types of Sound Tolerance

When sound hurts

  1. Hyperacusis
  2. Recruitment
  3. Hypersensitive hearing
  4. Misophonia
  5. Tonic Tensor Tympani Syndrome

You will find there is little understanding of how sound tolerance or sound sensitivity impacts you in the day to day existence. The idea of sound hurting is a difficult concept to understand when the sounds are not that loud. These unusual symptoms are readily misunderstood or not believed. Explaining such abnormal reactions to sound to other people, including at times health professionals, is difficult and those with sound tolerance problems often feel misunderstood, isolated and accused of malingering.

While the different types of sound tolerance issues can occur concurrently, they are separate and distinctly different conditions. All conditions have the potential to escalate, so that an increasing range of sounds become intolerable.

Reactions to sounds can range from mild through to severe or even extreme.

The good news is we are starting to understand what is happening and offer treatments.

What is Hyperacusis?

Hyperacusis is an abnormal intolerance to ordinary, everyday sounds and often comes on gradually or suddenly during times of strong emotions. It may develop in association with tinnitus and associated with anxiety and distress.

People with significant hyperacusis generally don’t tolerate any loud sounds; many moderate volume sounds, particularly if they are sudden and unexpected, and may not tolerate some soft sounds. High frequency (pitch) and low frequency sounds tend to be difficult to tolerate.

It can range from a person who is mildly uncomfortable in a restaurant setting wherein all the rest of the people at the table have no discomfort at all … to a person who has profound discomfort from many of the sounds encountered in daily life.

There are different categories of hyperacusis that mean require different treatment options.

The good news is that Tinnitus Retraining Therapy (TRT) and other desensitisation techniques can be highly effective in treating hyperacusis.

What is Recruitment?

Recruitment is officially described as a rapid growth of perceived loudness for sounds in the pitch region of your hearing loss. Recruitment causes your perception of sound to be exaggerated. Even though there is only a small increase in the noise levels, sound may seem much louder and it can distort and cause discomfort.

For example, my father in law had a significant hearing loss for several years before his death at the age of 92. I could say, “Dad.” He heard nothing, and he of course did not respond. So I’d say it a bit louder. Still nothing. A bit louder than that. Still nothing. And then … just a very tiny bit louder. The response: “Stop yelling so loud, Nolene, I hear you just fine. Tone it down a bit, will you!” And THAT’S recruitment – a rapid growth of perceived loudness in a pitch region containing hearing impairment. (And it is very difficult to convey to a person with significant hearing loss that the time he hears my voice at a level uncomfortable to his ears … was actually the *fourth* time I tried to get his attention.) This phenomenon occurs because at some decibel level, the normal hair cells adjacent to the damaged hair cells (corresponding to the frequency of a hearing loss) are “recruited.” At the decibel level at which these normal hair cells “kick in,” perceived loudness shoots up rapidly, causing discomfort.

My professional opinion is that TRT and various desensitization protocols do not help in these cases… what is required is hearing aids (with compression, if the recruitment is severe). BUT – just because a person has some hearing loss and also has sound sensitivity … it does not mean that the sound sensitivity is due to recruitment. Hyperacusis can occur in people with hearing loss!

What is Hypersensitive Hearing?

Some people are sound sensitive at birth but it is only specific to certain frequencies heard at loud levels, not necessarily very loud sounds either (typically above 70 decibels). 70 decibels is the level of slightly loud speech.

It’s like they are hypersensitive hearing to specific frequencies heard at loud levels.

You hear these frequencies labeled as “problem” frequencies. Autistic children are good examples of this. They can tolerate some sound at normal or even loud volumes but some frequencies are difficult to tolerable. Commonly children with Autism Spectrum Disorder (ASD) are able with therapy to ‘retune’ their ears and normalise their hearing tolerances.

Someone with hyperacusis is unable to do this as the therapy is too loud and may worsens the condition of the person with hyperacusis.

What is Misophonia?

Misophonia noise upset Misophonia is a word describing when you react to certain sounds, often made by other people, intruding into your space e.g.: the sounds of other people eating, neighbour’s music, noise from a nearby factory etc.

Severe misophonia can result in a fear of being exposed to a certain sound in the belief that it may lead to uncontrollably high levels of annoyance/distress and an inability to control the emotional reaction following exposure.

When misophonia develops everyday sounds begin to appear unnaturally prominent, increasingly louder and more strongly disliked. Following exposure to some or many of these sounds, high levels of anger and irritability can occur. This reaction can generalise to include more and more sounds. The escalating anxiety about the emotional reaction following exposure to these sounds can lead to an escalation in misophonia.

Our understanding of misophonia and different treatment options continues to grow. There are many myths and misunderstanding about misophonia so we have a whole page dedicated to the topic.

How does hyperacusis and misophonia affect people?

If you have hyperacusis and/or misophonia you often feel the need to regularly and sometimes constantly monitor your auditory environment to avoid intolerable sounds.

You may feel a need to protect your ears and sense of hearing from exposure to intolerable sounds. With misophonia, you are likely to want to limit the high levels of anger, irritability and distress you feel following exposure to intolerable sounds. As a result hypervigilance of the acoustic environment is common. Frequent monitoring of the ear symptoms is common.

At Hearing Care Professionals we understand how distressing and debilitating these conditions can be.

What is Tonic Tensor Tympani Syndrome?

In the middle ear, the tensor tympani muscle and the stapedial muscle contract to tighten the middle ear bones (the ossicles) as a reaction to loud, potentially damaging sounds. This provides protection to the inner ear from these loud sounds.

In many people with tinnitus, particularly if they have developed hyperacusis, an increased, involuntary activity can develop in the tensor tympani muscle in the middle ear as part of a protective and startle response to some sounds.

This lowered reflex threshold for tensor tympani contraction is activated by the perception/anticipation of sudden, unexpected, loud sound, and is called tonic tensor tympani syndrome (TTTS). This response can then generalise to other types of sound and to lower sound volume levels, resulting in the development as well as the potential escalation of hyperacusis. In some people with hyperacusis, it appears that the tensor tympani muscle can contract just by thinking about a loud sound.

TTTS typically does not develop in people with misophonia.

TTTS was first noticed in the 1980s when we started seeing people with Acoustic Shock while working in call centres.

TTTS symptoms in and around the ear(s) include: pain, numbness and burning sensations in and around the ear; pain in the jaw joint and down the neck; the development of tinnitus or an increase in pre-existing tinnitus; a clicking / fluttering sensation in the ear; a sensation of blockage, fullness or frequent “popping” in the ear; unsteadiness; muffled hearing.

It appears that TTTS develops from way sound is perceived in the brain. Strategies from tinnitus habituation and hyperacusis desensitisation will help reduce TTTS symptoms.


How can Hearing Care Professionals help?

Our programs for sound tolerance and/or tinnitus problems starts with an initial consultation of one and a half hours.

For many people, the information and guidance provided in one appointment may be sufficient to move towards a self-managed program of hyperacusis and misophonia desensitisation.

The number of appointments in your treatment program will vary depending on the severity of your sound tolerance issues and the on-going guidance and support you require. Hearing Care Professionals will keep you informed at each step what your options are going forward.

If you are having difficulty tolerating sounds others think are ok, please click here and book an appointment