Hyperacusis or Sensitive Hearing and Berard AIT
On-line AIT Checklist
Seymour, SLP/A, AIT Practitioner and
Professional Practitioner Trainer
Hyper-hearing, Hyperacusis or Sensitive Hearing and Berard AIT
condition is poorly understood by audiologists in my experience: there is a
greater appreciation of the condition by
AIT Practitioners than by audiologists, with a few exceptions.
It is not
always clear whether it is an exaggerated response by the nerves of hearing or
whether it is more appropriate to describe it as an exaggerated response by the
listener – in the sense of …”if a leaf falls in the forest and there was nobody
to hear it, was there a sound?..” debate.
There do seem
to be various conditions, and maybe different cases and different ways to treat.
There is a condition of
'exaggerated subjective response of loudness' by the ear / the listener
who has a tested audiogram ‘within normal limits” i.e. between 0 to 20 dB,
but finds certain sounds abrasive / painful / irritating.
There is a condition of
raised sensitivity as revealed by a hearing threshold above the 0 dB line,
sometimes called “bionic hearing” on certain frequencies or even on all
frequencies. Levels of -40 dB have been recorded, although most
audiometers only test up to – 10 dB. Such people
experience everyday sounds at a much louder volume than those with ‘normal’
hearing levels would, so are more prone to experiencing sounds as painful /
annoying / distracting / irritating.
Everyone can experience
painful hearing. The threshold for pain is normally reached around 120
to 140 dB. The area between the hearing threshold (0 to 20 dB) and the pain
threshold (usually 120 to 140 dB) is called the person’s “Dynamic
Range”. That is the range of loudness between threshold and pain in
which the ear / person can hear, and process sound for meaning.
There is a mechanism for
protecting the hearing called the “Acoustic Reflex”, which comes into action
when sounds reach the loudness of 80 to 95 dB (it varies per person).
The tympanic and stapedius muscles of the ossicular chain (the
little bones of the middle ear) clench tightly, impeding the passage of
sound to the inner ear, and thereby protecting the inner ear’s delicate
cells from damage caused by loud sounds. One can experience sounds at this
level as ‘loud’ even ‘too loud’ but not painful.
There is the kind of
painful hearing described for people with hearing loss, as tested in the
moderate to profound range – usually from 50 to 90 dB losses or greater,
with cochlear involvement, or inner-ear / nerve hearing loss involved.
These people need sounds made louder before they can begin to hear them, but
when they do begin to hear – at threshold – the sound is
immediately also painful. When the nerves of the cochlea are affected
the pain threshold is reached more quickly, For example, a person begins to
hear the frequency at 60 dB but experiences pain at 65 dB. This means
their Dynamic Range is only 5 dB as compared to the normal 100 dB or
thereabouts. This is what makes adjusting to hearing aids so difficult.
All of these conditions involve poor auditory
processing, but are these conditions essentially similar in origin? We know
that they are neurological (cochlea to brain) not peripheral (outer ear and
middle-ear). Although Dr. Berard said that in
the case of a spasmed acoustic reflex, the little muscles of the middle ear go
into spasm, which can cause the pain of painful hearing. This has not been
researched to date, but could be an interesting study.
The causes of
hyper-hearing, hyperacusis or sensitive hearing
painful hearing are various, and not clearly known.
known that nerve damage can cause painful hearing, in brain damage or
been described how nerve hearing loss can cause painful hearing.
It is known that
hyper-sensitivity in general (sensory integration issues) can also be
associated with painful hearing – if a child is hyper-sensitive in one
sensory domain, it is likely they will also be hyper-sensitive in other
sensory domains, since it is the processing organ not the sense - organ
that is operating defectively.
Nutritional problems, and
neurobiological differences, can be at the root of many painful hearing
cases. It has been documented that low magnesium levels especially
can lead to hyper-sensory problems, and that supplementation and even
mega-dosing with Magnesium and Vitamin B6, together with zinc and calcium,
can over a period of one to three months cause a pleasing reduction in the
pain of painful hearing.
Hyper-hearing, Hyperacusis or Sensitive Hearing with Auditory Integration
Metabolic assessment and
supplementation as mentioned above can be very effective for some. This is a
has proven itself effective for many cases and types of hyper-sensitive
hearing, with lasting benefits being documented.
The benefits of
Berard AIT alone, if
there is a metabolic issue left
untreated, could be limited.
The implication is that when
there are sensory processing
issues, a neurobiological assessment should always be performed to
determine whether the metabolic problem that caused the issue in the first
instance is still active.
Hyperacusis or Sensitive Hearing
There is a tendency for some with painful
hearing to wear ear protectors. This has been strongly disadvised by
Dr. Berard, since it
exacerbates the problem . The relief is short-term but the negative effects
However, when a person in the
throes of treatment has to expose themselves to sounds that cause them great
distress, it might be a
cautious and very brief help to them to allow the wearing of protectors,
noting that doing so must be for very brief periods
only, and is likely worsening the situation.