Tag Archives: Tinnitus

Hyperacusis: Intolerance to sound

Hyperacusis is a condition characterized by over-sensitivity to everyday environmental sounds which may be unpleasant or painful to the ear. Hyperacusis usually results from damage to the our auditory (hearing) system. It can be due to damage to the brain or the neurological system, In these cases, there is processing problem specific to how the brain perceives sound. .

Individuals with hyperacusis have difficulty tolerating normal sounds which are not loud to others such as sound from running water in the kitchen sink, ringing phones, shutting doors, shuffling paper, placing dishes on table, TV sound etc.

40% of patients with tinnitus complain of mild Hyperacusis and around 86% of Hyperacusis sufferers have tinnitus.

Tinnitus is the perception of sound within the human ear such as ringing sensation, when no external sound is present.

Hearing Loss with low tolerance to sound is different term known as recruitment, In Hyperacusis usually hearing is normal.

What causes Hyperacusis?

Hyperacusis may be caused by overexposure to excessively high loudness levels, head injury, stress, and genetic differences or by abnormal responses in the ear muscles, which protects the ear from loud sounds. Other causes may include adverse reactions to medicine or surgeries, chronic ear infections, autoimmune disorders, migraine and some forms of epilepsy.

In cochlear Hyperacusis, the symptoms are ear pain, annoyance and general intolerance to everyday sounds.

In some conditions, wherein the vestibular system is involved is called as Vestibular Hyperacusis. In this condition, the sufferer may experience feelings of dizziness, nausea or a loss of balance when sounds of certain pitches are present at certain level.

Anxiety, Stress and Phonophobia (fear of loud sounds) may be present in Hyperacusis. Sufferer may develop avoidant behavior in order to avoid a stressful sound situation or to avoid embarrassing themselves in a social situation which involves noise. This might lead the sufferer stay away from the society.

Diagnosing Hyperacusis

Understanding the mechanism of Hyperacusis is often challenging. People who develop Hyperacusis should have a thorough Evaluation by otorhinolaryngologist (Ear, Nose and Throat doctor) and a detail Audiological tests to determine the state of the Auditory- Vestibular system.

Treatment of Hyperacusis

Although a corrective medical or surgical approach for treating Hyperacusis is not available at this time, there are therapies that can help to reduce fears and anxieties towards sensitivity of sounds under guidance of an ENT Specialist and supervision by a Clinical Audiologist.

Antidepressant medicines and treating migraine may help.

Retraining Therapy for Hyperacusis

Retraining therapy consists of counseling and acoustic therapy. The aim is to reduce the patient’s reactions to Hyperacusis. Counseling is designed to help a patient better cope, while acoustic therapy is used to decrease a patient’s sensitivity to sounds and to teach them to view the sound in a positive manner.

Sound Generators

This treatment approach uses the sound of music or broadband noise or music produced via a body-worn system or a small device that looks like a hearing aid, which produces steady and gentle sounds. The theory is that, by listening to a sound at a low level for a certain amount of time each day, the auditory nerves and brain centers will become desensitized and able to tolerate normal environmental sounds again.

Constant use of earplugs/ earmuffs is not recommended because constant or frequent blocking of the ears may further alter the brain’s calibration of loudness which may lead the brain to further restrict its comfort range for sounds.

What to do in hyperacusis ?

1 .Avoid exposure to loud noise

  1. Avoid caffeine, chocolate, smoking , alcohol, MSG
  2. Avoid ototoxic medicines (medicines that might damage ear) such as aspirin, quinine)
  3. Daily exercise
  4. Adequate rest
  5. ENT & Audiological evaluation

Read more about Hyperacusis  http://www.tinnitus.org.uk/hyperacusis


General measures and prevention of tinnitus

Previous post- Treatment of underlying cause

Prevention is the best way to ensure no worsening of disease. Certain life style changes are required for tinnitus –

  • Take care of the body by giving it enough rest, sleep and water.
  • Dietary supplements Vitamins A, C, E, and B group and Zinc
  • Micro nutrients to prevent noise induced hearing loss
  • Support and stress management; taking a positive step in controlling the condition and changing response to it
  • Regular exercise
  • Decrease intake of salt
  • Avoid food with high sugar
  • Limit exposure to loud noise, occupational and recreational
  • Avoid aspirin, and NSAIDS
  • Avoid ototoxic medicine
  • Avoid nicotine, alcohol, caffeine
  • Take steps to lower blood pressure and cholesterol
  • Ginkgo Biloba extract is an effective, well tolerated whilst not effective in every single patient, the proven benefits far outweigh any risks.

Next post- management of tinnitus

Treatment of conditions causing tinnitus

( Previous post: – Treatment options for tinnitus)

Person should be assessed and investigated properly by otolaryngologist, audiologist and neurologist if required, to find any treatable condition; management of cause usually take care of tinnitus.

  • Stop medicines causing tinnitus.
  • Wax, foreign bodies can be removed.
  • Treatment of middle ear infections and fluid should be done.
  • Otosclerosis and tinnitus- Surgery and/or hearing aids; surgery may not cure tinnitus and a failed surgery can cause severe tinnitus but correcting conductive deafness (even with poor speech discrimination) allows masking effective.
  • Menieres disease- Tinnitus is difficult to treat in non functioning (dead) ear, so decision for destructive surgery should be taken with care.
  • Abnormal patency of ET- Mostly seen after weight loss, can be corrected by minor surgical correction (25% silver nitrate or diathermy)
  • Surgery for tumor
  • Hearing aids for hearing loss
  • Treatment of blood pressure/thyroid disorder/other medical conditions causing tinnitus.

Next post:

General measures and prevention of tinnitus

Management of tinnitus

Finding Cause for Tinnitus


Tinnitus is not a disease rather an annoying symptom of myriad of conditions, caused by minor changes in the sensitive hearing system (Cochlea and auditory nerve).


Patient with tinnitus should undergo thorough otologic and audiological evaluation and if required neurological examination. In most cases tinnitus is not harmful but patient should be investigated properly to find any treatable condition.

Most common cause for tinnitus is hearing loss because of aging, noise, drugs or chemicals.

Possible theory: –

  1. Because cochlea is no longer sending normal signals to brain, confused brain create own noise.
  2. Made worse by anything that makes hearing worse like infection/wax.

Causes: –

I. Related to ear (otologic)-

** Cause may be in the external, middle or inner ear

Subjective causes-

  • Impacted wax
  • Fluid in the middle ear
  • Acute and chronic otitis media
  • Otosclerosis
  • Menieres disease
  • Presbiacusis (age related hearing loss)
  • Head trauma
  • Noise-trauma
  • Ototoxic drugs (such as ACE inhibitors, Antibiotics-ciprofloxacin, erythromycin, streptomycin, and vancomycin, Anti depressant-alprazolam, Anti-malarials-chloroquine and quinine, B-blockers, Diuretics-acetazolamide and amiloride, NSAIDs and Aspirin)
  • Tumor (acoustic neuroma)

Objective causes are less frequent-

  • Aneurism of carotid artery (it is synchronous with pulse)
  • Vascular tumor of middle ear
  • Palatal myoclonus
  • Temporomandibular joint syndrome (misaligned jaw)
  • Tinnitus synchronous with respiration may occur with abnormally patent Eustachian tube (mostly seen after weight loss).

II. Not related to ear-

Disease of CNS, anemia, arteriosclerosis, hypertension, hypotension, hypoglycemia, epilepsy, migraine,

III.  Psychological-

Assessment of tinnitus-

Most important is History and Identification of hearing loss and Clinical Examination of ear by otoscope/operating microscope with detail head and neck examination by specialist.


  • Pure tone Audiometry, speech audiometry, if required special tests like SISI, ABLB etc.
  • Brain-stem Evoked Response Audiometry If tinnitus is accompanied with other complaints like  headache, vertigo, vomiting,
  • CT scan (especially if tinnitus is asymmetrical, 10% of cases it may be a tumor (Acoustic Neuroma).
  • Blood Investigations to test Anaemia- CBC, Hypothyroidism- TSH, Diabetes-sugar, Syphilis- FTABS and lipid profile.

Comprehensive evaluation of tinnitus and sound tolerance:

  • VAS loudness scale and the quality of life Tinnitus Questionnaire
    Pitch matching
    Loudness matching
    Post masking effect
    Feldman Masking curves

Most important aspect is educating person with respect to nature of tinnitus,  keep in mind treat the patient not the tinnitus…

Some Latest Research news:-

Hyperactivity of Touch-sensing Nerves in Head, Neck Causes Tinnitus

Scientists Exploring Brain Area Responsible for Tinnitus



Tinnitus is not a disease rather an annoying symptom of myriad of conditions, caused by minor changes in the sensitive hearing system (Cochlea and auditory nerve).

Tinnitus (means ringing in Latin) is sound sensation in the ear or head, in the absence of any external source of sound.  Commonest types are hissing, roaring, swishing, rustling, buzzing, humming, or chirping.

(Photo by nathaniel)

Tinnitus varies in pitch and loudness and is more annoying in quiet surroundings, particularly at night.  It can be quite disturbing leading to sleep deprivation, depression & decreased work efficiency. Most important aspect of tinnitus is distress, irritation and distraction caused by the noise. Person often feels that such noise is a symptom of brain tumor or stroke. In most cases tinnitus is not harmful.

Patient with tinnitus should undergo thorough ENT and Audiological evaluation and if required neurological examination. ‘Nothing can be done and you have to live with it’ is to be avoided and patient should be investigated properly to find any treatable condition.

Treatment of the cause should take care of tinnitus but tinnitus may persist even after the disease causing tinnitus has been cured, When a lesion or disease process is not identifiable, then tinnitus management is more difficult.

In majority of cases our system adapts to noise over a period of time and is accepted as a part of normal environment. This process can be helped by proper reassurance and counseling. Relaxation, biofeedback and Yoga help to improve coping with the condition.

Hearing aids are helpful for tinnitus with hearing loss and tinnitus maskers are sometimes recommended. These are similar to hearing aids and generate continuous noise. Their use is based on the fact that the patient is more comfortable in a noisy environment than in a quiet surrounding.

Research shows encouraging result on the effectiveness of pharmacological therapy for tinnitus, such as carbamazepine, lidocaine, and intravenous barbiturates, but potentially serious side effects limit their use.