Psychiatric Comorbidities and Hyperacusis
Juris et al (2013) report that sound sensitivity has been referred to through multiple names to describe various, overlapping, and multiple degrees of (arguably) similar phenomena. For example, terms and phrases such as hyperacusis or decreased sound tolerance or hypersensitivity to sounds or phonophobia may appear synonymous to some, while others apply more specific definitions to each term.
Juris et al note that the term hyperacusis might be defined as "consistently exaggerated or inappropriate responses or complaints to sounds that are neither intrinsically threatening nor uncomfortably loud to a typical person" or perhaps "unusual intolerance to ordinary environmental sounds."
The authors report that the etiology and natural causes of hyperacusis are largely unknown and, for the majority of patients, no underlying medical condition is ever found. However, Juris et al report co-morbidity rates between tinnitus and hyperacusis have been reported between 38 and 85 percent (Andersson et al, 2001). Juris and colleagues hypothesized individuals with psychiatric disorders (particularly those with anxiety-related disorders) would likely be "over-represented" among patients with hyperacusis.
Sixty-two patients were included in their study at Uppsala University Hospital, Sweden. The majority of the patients (89 percent) reported avoidance of noisy situations and 82 percent reported using hearing protection devices (HPDs) in situations where average people did not (situations such as driving a car, riding in a bus and in different social situations). Of note, the authors report overprotection of ears should be avoided as it progressively exacerbates hyperacusis, thus perpetuating the disorder itself. Seventy-nine percent of the 62 (hyperacusis) patients reported tinnitus, arguably suggesting a common mechanism.
Juris et al report that 56 percent (35 of the 62 patients) met criteria for at least one psychiatric disorder. Twenty-nine (of the 35) had an anxiety disorder. Indeed, social phobia was the most common disorder; generalized anxiety disorder was the second most common disorder, followed by agoraphobia. Of note, the majority of patients in this study had academic professions.
The authors suggest cognitive behavioral therapy (CBT) is an effective form of psychological treatment and should be considered as a "first-line psycho-social treatment" for many/most patients who demonstrate anxiety and/or somatic conditions in which anxiety is a factor such as tinnitus and/or irritable bowel syndrome, and recurrent cardiovascular events, and CBT should be explored with regard to hyperacusis.
For More Information, References, and Recommendations
Andersson G, Vretblas P, Larsen HC, Lyttkens L. (2001) Longitudunal Follow-Up to Tinnitus Complaints. Arch Otolaryngol Head & Neck Surg 127:175-179.
Juris L, Andersson G, Larsen HC, Elselius L. (2013) Psychiatric Comorbidity and Personality Traits in Patients with Hyperacusis. International Journal of Audiology 52:230-235.