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Types of Sound Sensitivity: Hyperacusis, Hyperacute Hearing, Recruiment, Phonophobia and Misophonia
Portions reprinted from Hyperacusis.net

"HYPERACUSIS
These individuals have a collapsed tolerance to normal environmental sound. The term commonly used to describe this condition is 'hyperacusis'. Hyperacusis can come on gradually or occur suddenly where the patient finds themselves in a state of crisis. Patients who have a collapsed tolerance to sound need to have their Loudness Discomfort Levels (LDL's) established by a hearing healthcare professional. Normal LDL's are in the 85-90+ decibel range. Patients with hyperacusis would have LDL's well below that level. The common treatment for hyperacusis is listening to broadband pink noise though sound generators (special hearing aids) which must be ordered through a specially trained doctor or audiologist who administers Hyperacusis (Tinnitus) Retraining Therapy. The therapy often costs $3000-$4000 (depending on the clinician) and typically is not covered by insurance.

RECRUITMENT
There are many more individuals who have recruitment. Recruitment is the a rapid growth of perceived loudness for sounds in the pitch region of a person who has hearing loss. 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. In other words, at one point the person cannot hear the sound because they have hearing loss (in that frequency), then when the sound reaches a certain loudness and/or frequency the person is blown away. Once they finally hear the sound, it is perceived as far too loud. Recruitment is a common phenomenon in cultures where the majority of their lives have been saturated with too much noise – like our Western culture. Common treatment is the same as it is for hyperacusis unless the persons hearing loss is so pronounced that listening to broadband pink noise would be of no benefit to them.

HYPERACUTE HEARING
Then there are individuals who are sound sensitive at birth but it is only specific to certain frequencies heard at loud levels (typically above 70 decibels). It may seem like we are splitting hairs here but remember – the key words with hyperacute hearing are – sound sensitive to specific frequencies heard at loud levels. These frequencies are typically labeled 'problem' frequencies. Autistic children are good examples of this. They can tolerate some sound at normal or even loud volumes but some frequencies are intolerable. Commonly autistic children, children who are marginally autistic, or non-autistic individuals who have hyperacute hearing are treated with auditory integration therapy (AIT).

AIT takes regular music and filters out the problem frequencies through a special machine called an Audiokinetron. Somehow this therapy seems to 'retune' their ears and normalizes their hearing tolerances. The music is listened to at decibel levels which can peak up to 90 decibels. This creates a problem for the hyperacusis patient. The therapy is too loud and only worsens the condition of the hyperacusis patient whose Loudness Discomfort Levels have been compromised. Hyperacusis and recruitment share part of a common pathway but in some ways we are very different and our retraining therapies run very much a different path.

PHONOPHOBIA
Now it is important to address two symptoms which often accompany hyperacusis. They are phonophobia (fear of sound) and misophonia (dislike of sound).

Phonophobia often develops with an individual who has a significant collapsed tolerance to sound. They not only fear the sound of the environment they are experiencing in real time (right now) they worry about the sound that future events of the day or in the near future will produce. Phonophobia can take over ones life and make one feel they need to isolate themselves to survive. This is a recipe for disaster. It is critical that we keep our ears active to rebuild our tolerances to sound. That is why broadband pink noise is so crucial to bringing us back to the mainstream of life.

MISOPHONIA
Misophonia (dislike of sound) has often been thought of as hyperacusis. This is not true. Let us be clear here. A hyperacusis patient can have a strong fear of sound (phonophobia) and a general dislike of sound (misophonia) but neither one of these symptoms stand alone as hyperacusis. The two terms address either a fear or a strong dislike. Hyperacusis is a collapsed tolerance to normal environmental sounds. They hyperacusis patient may or may not have phonophobia and/or misophonia. If the hyperacusis patient IS also dealing with phonophonia and/or misophonia then their clinician needs to address these issues is addition to treating the patient for hyperacusis. It is also important to note that a person can have phonophobia and/or misophonia and not have hyperacusis at all. Sound confusing. Let's talk...

We will discuss forms of misophonia. They are not a separate catagory of sound sensitivity because the issues we are about to talk do not involve loud sounds. We will explore two forms of misophonia that are frequently reported:

(a) Individuals whose hearing sensitivity is focused on eating/chewing sounds: Some individuals are not sensitive to loud sounds (in other words they have normal loudness discomfort levels - LDL's) but they are unable to tolerate the sound of people eating or chewing. Oddly enough they have no problem tolerating the sound of their own eating. These individuals have a difficult time eating with their family and friends and some insist on eating all by themselves. They become enraged at meals and sometimes even start to shake or convulse. This is not hyperacusis. The patients primary goal would be to neutralize the dislike they have on eating sounds. Most of these individuals live very normal lives with the only exception of being unable to tolerate all the dynamics of other people eating. Often these individuals have been unsuccessful finding any information about this condition. To the best of our knowledge no articles have been written in any qualified medical journal and no studies or research has been done about this. Patients seeking treatment from their clinician may have to copy the information from this website to help their doctor understand what is taking place here. Treatment for these patients comes from clinicians who have a specific protocol for misophonia. Search the network message board with the word misophonia to learn more about this problem and misophonia protocols.

(b) Individuals that are sound sensitive at soft levels. Some have called this condition Selective Soft Sound Sensitivity or 4S. These individuals are sensitive to particular sounds which are not loud in volume. For example, some individuals have a hearing sensitivity to certain consonants (i.e. s, t, p, c). Once again, although this is a sound sensitivity issue, this is not hyperacusis. This also is misophonia. These individuals are bothered by these sounds whether someone else produces the sound or they produce the sound themselves. That is clearly different from the patient who is seriously impacted by the sound of others eating.

A final word about misophonia. This is a symptom which is misunderstood. Even the word 'misophonia' was invented by Dr. Pawel Jastreboff to help clear some of the misunderstanding. Aside from a misophonia protocol it is not clear whether broadband pink noise helps the patient improve their dislike of sound. Time will tell. We are all learning."

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