Situations Avoided by People with Hyperacusis

Hyperacusis is characterized as when moderately intense sounds create abnormal loudness reactions. This condition induces considerable distress and negatively impacts the quality of life for millions of individuals worldwide.1,2 Hyperacusis prevalence has been observed in 8-17% of the general population.3 Hyperacusis profoundly hampers daily social, professional, and recreational activities.4 Furthermore, it has the potential to lead to anxiety and depression.5–7Hyperacusis manifests through four primary symptoms: loudness, annoyance, fear, and pain.8 Loudness hyperacusis occurs when moderately loud sounds, such as a baby crying or loud music, become extremely uncomfortable for the patient. In annoyance hyperacusis, patients experience significant discomfort from certain sounds, such as sniffling or coughing, even if they are not excessively loud. Fear hyperacusis involves patients anticipating and avoiding situations with significant sound exposure. Pain hyperacusis is often reported by patients who feel ear pain when exposed to moderately intense sounds. It is common for patients to exhibit overlapping symptoms, such as finding sounds perceived as very loud to also be annoying.9 Consequently, individuals with hyperacusis tend to avoid situations that could lead to distressing experiences.10 Several approaches, such as Hyperacusis Activities Treatment, are used by patients to manage their hyperacusis symptoms.8 This paper presents the primary situations and sounds reported by hyperacusis patients to be challenging.9,11 This information can assist clinicians by streamlining the initial interview process and aid in selecting appropriate counseling and sound therapy options for each individual with hyperacusis. 1. THE KITCHEN Some individuals with hyperacusis report that dishes clanging together in the kitchen can be very upsetting. To avoid this annoying situation, they can communicate to others that they would prefer to leave the kitchen before the table is cleared, or to carefully clear the table and clean the dishes (including placement in the dishwasher) themselves, without assistance. Support from a partner or family is important to clearly communicate one’s needs when exposed to loud sounds in the home. “Successive approximations,” which puts the patient in control, can also help. Patients listen to recordings of sounds they find annoying or fearful while seated and comfortable. They begin listening at very low levels. At their own discretion, they can increase the sound level and the duration of listening. They can do this in the kitchen, first with recordings, then with actual dishes and appliances. Lastly, they can have trustworthy, attentive others in the kitchen following their instructions to make sounds with dishes. With this control, hyperacusis patients can gradually expose themselves to uncomfortable sounds to build up their tolerance of them. Audiologists should advise individuals with hyperacusis that they should wear hearing protection when in the presence of potentially damaging, high intensity sounds. Avoiding sound alone can exacerbate sound sensitivity.8,12–14 Adding sound gradually to the patient’s environment can improve sound tolerance. 2. RESTAURANTS Many restaurants have excessive noise and are avoided by hyperacusis patients. This excessive noise can include loud ambient music, people talking loudly, glasses clinking against tables, cutlery making noise in dishes, staff clacking on keyboards, and espresso machines grinding and roaring. Additionally, modern design trends tend to amplify noise: tall ceilings and larger rooms with more tables can enhance sound. Without textiles on tables or carpets on floors, sound is unabsorbed and free to rebound around the space and directly into ears. When hyperacusis patients decide to try a restaurant, they can certainly bring along earplugs to protect their hearing. Filtered or musician earplugs are best in these situations, as they reduce the overall sound level and bring comfort to the individual while maintaining speech for good communication. Additional tips for navigating a noisy restaurant as a person with hyperacusis include: Sit in a position where you can easily see talkers. Select quieter restaurants. Notify owners or managers about your noise concerns. Go early before the restaurant gets crowded and busy. Sit in an area off to the side or away from any loud speakers. Ask the manager to turn down the volume if there is loud music. Use relaxation or mindfulness exercises such as deep breathing to keep calm when noise levels rise. There are also apps dedicated to helping people find quieter bars and restaurants. Some apps have an internal sound level meter that measures the noise level of any venue, and can determine if a given venue is quiet, loud, or very loud. 3. MUSIC IN RELIGIOUS SERVICES Many churches and religious venues have excessively loud music, often avoided by individuals with hyperacusis. Loud music in church services can give the impression of the room being fuller; louder volumes encourage people to participate; and it can project a celebratory tone, rather than a somber one. Here are some measures individuals with hyperacusis can take so that discomfort with sound does not become an impediment to participating in religious activities: Choose quieter churches. Attend services at times when the church is less crowded. Sit in a quieter location. Bring along earplugs or earmuffs to protect hearing while enjoying the music. Ask the venue to reduce the sound intensity of music and speakers. Use relaxation or mindfulness exercises such as deep breathing to keep calm when noise levels rise. 4. MUSICAL PERFORMANCES One of the main complaints from individuals suffering from hyperacusis is the challenge of attending musical performances, such as rock concerts or symphonies. These settings feature excessively loud sounds that lead to discomfort, pain, panic, or irritation for those with hyperacusis. Hyperacusis patients are strongly advised to wear hearing protection when attending musical performances. In addition to offering greater safety, this practice reduces the likelihood that patients will develop tinnitus or hearing loss as a result of exposure to intense sounds. Increased auditory symptoms can exacerbate discomfort and further worsen the quality of life for individuals with hyperacusis. People with hyperacusis can sometimes request headphones from the venue so they can tune into the performance at their own volume. Instead of sound being projected into the open space at high volume, individuals can set the volume of their own headphones according to their comfort level. 5. APPLAUSE Applause at live performances can also contribute to auditory discomfort. If individuals with hyperacusis cannot avoid events, whether small or large in scale, where this reaction is anticipated, we suggest: Encouraging audiences to wave hands or snap quietly instead of clapping. Sitting as far away from the applause as possible to minimize the impact of this sound. 6. WORK Many people with hyperacusis prefer to work remotely to avoid loud or bothersome sounds at their workplace. The stressor is not necessarily the sound intensity itself, but the unpredictability and lack of control over sounds that they may be exposed to. To alleviate discomfort from sounds, workers can adopt some strategies such as: Inform your supervisor about your hyperacusis and request that fellow employees be required to keep noise levels down. Ask for measures to reduce noise-generating equipment in the work environment. Explore the possibility of moving to a different location or a room with a door, rather than a cubicle. Request permission to use noise-cancelling headphones to listen to low-level music or sounds. Use filtered earplugs when sounds are too loud. 7. HORNS, BELLS, SIRENS The sounds of bells, sirens, and horns are frequently cited as uncomfortable for individuals with hyperacusis. These continuous and sharp sounds can be particularly challenging to manage and may even cause ear pain. Investing in high-quality filtered or musician earplugs can reduce the intensity of these sounds when avoiding exposure is not possible. Patients can change out the filters in musician earplugs to continue their work on their public sound tolerance. They could, for example, start with a 25dB filtered plug, then change to 15dB when that is more manageable, and perhaps move to 9dB once they can tolerate the sounds at 15dB sound attenuation. SUMMARY There are many strategies hyperacusis patients can adopt to minimize their discomfort in common situations they would typically try to avoid. It is important to emphasize that an audiologist’s therapeutic and counseling approach should be patient-centered and tailored to their individual needs. Thoughts on something you read here? Write to us at [email protected].