Hyperacusis is an increased sensitivity to sounds that other people perceive as having normal intensity. It is observed in injuries, diseases of the labyrinth, neuritis, migraine, multiple sclerosis, amaurotic idiocy, meningitis, and a number of other pathologies. It is diagnosed on the basis of complaints, the results of an otolaryngological and neurological examination, and additional studies. Treatment is carried out by drug therapy, physiotherapy. Sometimes blockades are performed, operations are carried out.
Hyperacusia is a decrease in tolerance to sounds of normal volume. The disorder is characterized by painful sensitivity, inappropriate or exaggerated reactions to sounds that others perceive as normal (non-threatening, not too loud).
Hyperacusis is a broader concept than phonophobia (a pathological fear of sounds) or misophonia (a feeling of dislike towards sounds), which suggest the presence of negative emotional associations. It includes both the listed disorders and disorders in which sounds are painfully perceived, regardless of the psychological state.
Why does hyperacusis occur?
Labyrinth defeats
There are the following diseases of the inner ear that cause hyperacusis:
- Meniere's disease. There is an extremely intense systemic dizziness of a paroxysmal nature. During attacks, nausea, vomiting, impaired coordination, noise and congestion in the ear, palpitations, and shortness of breath occur. The duration of the episode ranges from several minutes to several days, more often 2-8 hours.
- Perilymphatic fistula. Communication between the inner and middle ear is formed against the background of injuries, otitis media, intracranial hypertension. It is manifested by dizziness, noises, a feeling of stuffiness in the ear. Hyperacusia is caused by an increase in symptoms with sufficiently loud sounds. Manifestations also increase with coughing, sneezing, changes in atmospheric pressure.
- Otosclerosis. Accompanied by loss of stirrup mobility, conductive and sensorineural hearing loss. Women are more often affected. The disease is asymptomatic for some time, then the perception of low tones suffers with possible hypersensitivity to high tones, which is manifested, for example, by a poor understanding of male speech during hyperacusis during a conversation with a woman or child. In the future, the perception of high sounds also deteriorates.
traumatic injury
A possible cause of the symptom is acoustic trauma. In the acute form, severe pain, sudden hearing loss, combined with dizziness, squeaking, ringing in the ears are observed. During the recovery period, hyperacusis may form. In the chronic course, the violation is expressed at the stage of initial manifestations, subsequently replaced by hearing loss and tinnitus.
Postconcussion syndrome is considered a common complication of traumatic brain injury. Most common in concussions. Possible dizziness, persistent cephalalgia, hyperacusis, insomnia, nocturnal awakenings, anxiety, fatigue, decreased mood, emotional instability. There is a slight deterioration in cognitive abilities - memory, concentration.
Diseases of the cranial nerves
A common neurological cause of hyperacusis is facial neuritis. Formed after hypothermia, viral infections, otitis media, injuries. It is characterized by asymmetry of the face, weakness of facial muscles and partial loss of taste sensations on the side of the lesion. Ramsay Hunt syndrome is caused by the herpes virus. General hyperthermia, rashes on the ear, tongue and soft palate, mild paresis of the facial muscles on the affected side, hyperacusis, and prosopalgia are found.
Hyperacusia
Migraine
The disease is manifested by paroxysmal cephalgia, spreading to one half of the head (usually the right one). Occasional side changes are possible. Hyperacusia in the form of phonophobia accompanies all forms of migraine: simple, with aura, menstrual, etc. The symptom is especially pronounced in migraine status - an attack that lasts more than 3 days. May accompany migraine stroke, which, along with hemicrania, is characterized by neurological disorders that persist for a week or more.
Meningitis
Hyperthermia, intoxication syndrome, excruciating bursting headaches, increased muscle tone, painful reaction to any stimuli: light, noise, touch are considered typical manifestations of various forms of meningitis. Hyperacusia is detected in the following types of leptomeningitis and pachymeningitis:
- Bacterial: pneumococcal, meningococcal, tuberculosis, with Lyme disease.
- Viral: enteroviral, acute lymphocytic and others.
- Fungal and protozoal: candidal, with toxoplasmosis, malaria.
Noncommunicable neurological diseases
The symptom is often found in multiple sclerosis. Early signs of pathology are weakness in the legs, radicular pain, optic neuritis, nystagmus. Subsequently, spastic paraparesis or tetraparesis, ataxia, intentional tremor, and chanted speech develop. Hyperacusia is also characteristic of an early form of amaurotic idiocy - Tay-Sachs syndrome. Occurs at the initial stage, further supplemented by a decrease in motor activity, vegetative disorders, muscle hypotension, bulbar syndrome.
Mental disorders
In patients with post-traumatic stress disorder, hyperacusis has a pronounced emotional component. Sounds are perceived as unexpected, frightening, signaling danger. Hypersensitivity to any irritants against the background of psycho-emotional exhaustion is noted. There are flashbacks, insomnia, aggressiveness, emotional lability, and unpleasant somatic sensations.
In depression, hyperacusis is formed against the background of emotional instability, increased exhaustion. It is more often manifested in patients suffering from neurotic depression with a pronounced anxiety component. Other signs are a steady decrease in mood, painful insensitivity, slowing down of speech, movements and thinking. Thoughts of suicide are possible.
Diagnostics
If labyrinth diseases are suspected, diagnostic measures are carried out by an otolaryngologist and a vestibulologist. Patients with neuritis, meningitis and other neurological pathologies are examined by a neurologist. For mental disorders, a consultation with a psychiatrist or psychotherapist is indicated. During the survey, they find out the time of occurrence of hyperacusis, its connection with external factors, and other symptoms.
With migraine, the establishment of the nature of cephalgia is of high importance. When collecting an anamnesis, the presence of chronic otitis media, TBI, diseases accompanied by increased intracranial pressure are clarified. When diagnosing acoustic injuries in the life history, episodic or constant exposure to high noise conditions is detected. To clarify the diagnosis, procedures such as:
- Otoscopy and microotoscopy. Changes are uncharacteristic for Meniere's disease. Acute acoustic injuries are accompanied by rupture, chronic ones - retraction of the tympanic membrane. With perilymphatic fistulas, edema and hyperemia of the membrane are noted, the light reflex is weakened. With otosclerosis, the Hombgren triad is determined, a local decrease in skin sensitivity, sometimes atrophy or hypertrophy of the membrane.
- Neurological examination. In post-concussion trauma, there are no neurological disorders, there is autonomic dysfunction. With neuritis, weakness of the muscles and impaired sensitivity of half of the face are revealed. With meningitis, meningeal symptoms are found, with migraine stroke and multiple sclerosis, a characteristic neurological deficit.
- Auditory analyzer research. Recommended for pathologies of the labyrinth and acoustic trauma. The list of techniques may include tuning fork, speech and tone threshold audiometry, otoacoustic emission, electrocochleography, acoustic impedancemetry. The scope of the examination is determined depending on the nature of the violation.
- Studies of the vestibular apparatus. Necessary when engaging the labyrinth. Vestibulometry, computer stabilography, indirect otolithometry are prescribed. For various diseases, hypo- or hyperreflexia may be characteristic. With Meniere's disease, these conditions replace each other depending on the time of the examination (paroxysm or interictal period).
- Other hardware techniques. As part of the examination, X-ray of the temporal bone, CT and MRI of the brain can be performed. A number of patients are shown electroencephalography and echoencephalography, extra- and transcranial dopplerography, duplex scanning. With neurological pathologies, electromyography, electroneurography, and the study of evoked potentials are prescribed.
- Spinal puncture. It is the main method for diagnosing meningitis, it allows you to verify or refute this diagnosis. The fluid flows out under pressure, with serous processes it is transparent, with purulent processes it is cloudy. According to the results of the analysis, pleocytosis, an increase in protein levels, and sometimes a decrease in the amount of glucose are determined.
- Laboratory tests. With ganglionitis of the geniculate node, the herpes zoster virus is detected by ELISA or PCR, an immunogram is prescribed to detect possible secondary immunodeficiency. With amaurotic idiocy, a sharp decrease in the level of gescominidase A is noted in a biochemical blood test, and signs of cell degeneration are found according to the results of microscopy of neurons.
In the diagnosis of migraine, a characteristic clinical picture, the absence of changes according to additional studies, plays a decisive role. Patients with postconcussion syndrome, PTSD and depression are shown psychological testing to assess personal characteristics, emotional-volitional and cognitive spheres, and identify characteristic signs of mental disorders.
Otoscopy
Treatment
Conservative therapy
Therapeutic tactics for hyperacusis is determined taking into account the cause of the pathology:
- Labyrinth defeat. As part of the long-term treatment of Meniere's disease, agents are used to stimulate microcirculation, venotonics, diuretics, and neuroprotectors. Paroxysms are stopped with the help of neuroleptics, antihistamines, vasodilators and diuretics. Recommended training of the vestibular apparatus. With perilymphatic fistulas, antispasmodics, antiplatelet agents, and multivitamins are used.
- Traumatic injuries. Chronic acoustic trauma is considered an indication for a career change. Antihypoxants, nootropics, B vitamins are useful. Darsonvalization and hyperbaric oxygenation are effective. With postconcussion syndrome, vegetative stabilizers, antispasmodics, nootropics, neurometabolites, and psychological correction are required.
- Neuritis. With Bell's syndrome against the background of other pathologies, the underlying disease is treated. At the initial stage, medications with a vasodilating and anti-edematous effect, glucocorticoids are prescribed. Subsequently, physiotherapy, exercise therapy, massage are used. Patients with ganglionitis in the acute period are shown antiviral agents, immunotherapy, and subsequently - anticonvulsants, anticholinesterase and sedative drugs, drugs to improve microcirculation, reflexology.
- Migraine. Relief of paroxysms is carried out using combined analgesics, codeine-containing agents. If symptoms persist for a long time, triptans are prescribed. Migraine status is an indication for the introduction of glucocorticoids and ergot preparations, antiemetic and psychotropic pharmaceuticals, intraosseous and periosteal blockades.
- Meningitis. Hospitalization is in progress. Purulent processes require antibiotics and sulfonamides. Tuberculous meningitis requires continuous administration of two or three antibacterial agents. For viral meningitis, general strengthening and symptomatic drugs are used; in severe cases, diuretics and corticosteroids are added to the regimen.
- Multiple sclerosis. With exacerbations, pulse therapy with glucocorticoids is performed, plasmapheresis can be used. To stabilize the condition and prevent progression, immunomodulators and immunosuppressants are recommended. Symptoms are eliminated with the help of stimulants, antidepressants, barbiturates, beta-blockers, anticonvulsants.
Surgery
Patients with hyperacusis undergo the following surgical interventions:
- Meniere's disease: decompression operations (drainage of the endolymphatic sac, fenestration of the semicircular canal, perforation of the base of the stirrup), laser destruction of the labyrinth, cervical sympathectomy.
- Perilymphatic fistula: tympanotomy, atticoanthromastoidotomy.
- Otosclerosis: stapedoplasty, labyrinth fenestration, stirrup mobilization.
- Bell's palsy: Nerve stapling or neurolysis in traumatic injury, nerve trunk plasty using branches of a healthy facial nerve from the opposite side.