Sound Sensitivity Types:
Hyperacusis, Hyperacute Hearing, Recruitment,
Phonophobia and Misophonia
On-line AIT Checklist
Portions reprinted from
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 $3,000 - $4,000 depending on the clinician and typically is
not covered by insurance.
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.
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).
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).
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.
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
Misophonia (dislike of sound) has
often been thought of as hyperacusis. This is not true. Let us be clear here.
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.
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 addressing 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.
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
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