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Author: admin, 05.11.2013
This term is used when an individual complains about being intolerant of the loudness of sounds that most people do not feel are loud. Hyperacusis can be defined as an abnormally strong reaction to sound along the auditory pathways.
Misophonia and phonophobia is an abnormally strong reaction of the autonomic and limbic (fight or flight reaction) systems resulting from enhanced connections between the auditory and limbic systems. The first, and most controversial, is to have the individual avoid the concerning sounds and to use hearing protection (ear plugs) on a regular basis.
The second approach involves desensitizing the individual by exposing them to a variety of sounds. Auditory desensitization aims to reduce the over-sensitivity of the hearing system to the sounds that the child finds uncomfortable. Noise generators (which are also tinnitus maskers and look like hearing aids) can be used to reduce the sensitivity of hearing for people with hyperacusis. A noise generator produces a steady, wide-band noise.
The aim of using noise -generators is to improve a person’s ability to tolerate normal exposure to sound, by reducing the sensitivity of the ear. The precise way that this occurs is not understood. The most effective management of hyperacusis is to use noise-generators in parallel to a program aiming to reduce fear and anxiety associated with sound exposure. The device has a volume control to change the intensity level of the sound that it gives out.
When the child has been using the maskers quite comfortably for six hours per day without any problems, the level of the noise output should be fractionally increased.
After about two months of use it is helpful to repeat the incident diary for a full seven day week, recording all noise-associated behaviors, as done at the outset of the masker use.
The use of noise generators with hyperacusis in adults may typically go on for 12 to 18 months. By default, HearAid will group together and print claim items with the same service date or for the items selected by using Ctrl+Click. Entering a Fitting Item will automatically expand the Devices Section which stores device details for fitting claims. Widex now offers the popular receiver-in-the-ear hearing aid to people with severe to profound hearing loss.
Familes have important information to share with school teams when children start school!  Starting School LIFE (Listening Inventory For Education) – This tool records the valuable information from the family’s completion of the CHILD, along their observations of their child as a communication partner and their level of independence.
Adapting the learning environment to support the learner with hearing loss:  Children with Hearing Loss – Helpful Adaptations in the School Environment – Listening and learning in the classroom can be very challenging for students with hearing loss. That said, when a child or student shows signs of oversensitivity to sound it is typical for those concerned to reach out to specialists in hearing loss for answers.
They can report pain in loud sounds, but more often it is discomfort, aversion, dislike, fear or anxiety related to sounds.
The person can describe experiencing physical discomfort as a result of exposure to sound (quiet, medium or loud). Importantly, misophonia and phonophobia do not involve a significant activation of the auditory system. In other words, a person who has experienced discomfort from sound can develop anxiety or fear when that sound or other sounds occur that are not really uncomfortable, but are judged to be somehow similar.  Importantly, note that neither hyperacusis, misophonia or phonophobia have any relation to hearing thresholds. Recording observations at school, child care, and home for a full week, including weekends is suggested. They further describe the isolating nature of the condition, and the impossibility of getting others to understand what it is they experience, which can lead to withdrawal and depression. Repeated gentle exposure to the noise may help the child to reduce anxiety and desensitize the auditory aspect of the sensitivity.
Although presenting sound through this process is not the same as unexpected exposure to the sound (they can often cope better if they are warned that a sound is about occur), people with hyperacusis say that this desensitization process is helpful. Children should not be forced to stay in a situation that is causing them obvious distress (for example during singing in assembly).
Older children may be reassured if they are told they have the teacher’s permission to leave the classroom for a few minutes at any point if they are exposed to an aversive noise. This allows outcome measures to be kept for the intervention and to build support for funding requests for maskers.

The addition of a masking noise to hearing of everyday sounds gives an immediate improvement, presumably by reducing the harshness of individual sound signals.
It is not aiming to mask out or reduce the level at which the person can hear the sounds causing discomfort. The sound is fed into the ears through an open ear mold, which is designed so that it does not block the ear canal, as this would result in loss of some background sounds. This should be set at the beginning of the session or day in a quiet situation when the subject is calm and relaxed. This will usually be in the home in quiet situations, but will gradually include other environments such as in school and while travelling. The new level should not be challenging to the wearer, but they may need time to acclimate to the new level. In practice, with the majority of children who have been fitted to date, there has been immediate acceptance of the maskers, and the children have very quickly got used to volume changes, sometimes even turning them up and down as necessary in different listening conditions. Some children have just suddenly decided not to wear the maskers anymore, having worn them happily and to great benefit for many months. After this period, most people find a long-term improvement has occurred in their sensitivity without the noise generators. Although we cannot predict how long this may take in children (and those with a learning disability) the desensitization should still be carried out over a finite period of time. Occasionally, however, it may be necessary to print separate claim forms for individual items (e.g. By rating your child’s listening behaviors for various situations you are identifying different settings in which he or she may have challenges.
It combines this information with results of the school’s eligibility assessment or annual assessment. This information provides an overview of classroom accommodations and expectations that the school team can address to meet these needs. It provides a quick screening of the child’s functional ability as compared to typically developing age peers (class peers for kindergarten) in the areas of Pre-academics, Attention, Communication, Class Participation, and Social Behavior.
Negative reactions to sound can occur regardless of whether a person has typical hearing or a hearing loss. Individuals have negative attitude to sound (misophonia), or are afraid of sound (phonophobia).
Individuals with these complaints may have normal hearing, and they may also have impaired hearing. In general, how much impact (1-10 scale) is there for the aversion to sound at school and home (specific situations can be considered, i.e, bus, lunch).
Continually dampening perception of sound through the use of earplugs results in making the auditory system even more sensitive to sound (after listening in quiet even typical sounds can be perceived of as loud). So encourage the child to clap his own hands, to play with noise makers or to start and stop the vacuum cleaner at home.
Most children do not abuse such an arrangement and are greatly reassured to know that they can leave a room, for a short time, if noise becomes distressing to them. The important aspect is to keep the signal carefully graded to be acceptable, and under the control of the listener.
However there is a longer-term benefit that is seen when the maskers are not in use in that there is a gradual improvement in the tolerance of sounds, which suggests some sort of control on the overexcitability in the auditory system. This technique requires long-term, low level, noise exposure while maintaining normal access to everyday environmental and speech information. Although there are noise generators which go into the ear canal, they are not appropriate for hyperacusis desensitization as they reduce access to normal sound.
If the background level of sound increases in any situation, the noise generator output should be kept at the initial setting even if the wearer can no longer hear it. As the wearer becomes used to the devices, it may be helpful to keep a short-term diary of times of use and any perceived effects. As it seems that auditory over-sensitivity is increased with generalized stress and anxiety, it is important that anxiety issues are addressed in parallel to this process. Complete a third incident diary to check that there are no residual behaviors that can be identified. As device codes are selected the program will fill in default Category (if needed for a Top-up fitting), Amount and Tax values, but these values can be modified if necessary.
This information can be useful for transitioning into school (see Starting School LIFE below) or may help families understand how their communication patterns may need to change to encourage the child to become an assertive communicator.

The gathered information provides important insights into the child’s communication strengths and listening needs for consideration of potential placement, classroom accommodations or skill building needs. There is a scoring grid that rates the child as typical or at-risk for Communication or Social Behavior in each of these areas.
Sound tolerance issues often occur in ears where an individual experiences tinnitus, or ringing in the ears.
The family and school should work together to develop a hierarchy listing sounds with no response, minimal response, significant response, and extreme responses. The end result is that the hyperacusis is exacerbated rather than improving the functionality of the individual.
In this case presenting increasingly loud levels of the sounds associated with negative reactions are paired with engaging in fun or interesting activities. There is likely to be a learned association of fear and anxiety when the child is in situations where uncontrolled sound exposure may occur. In order to break down the learned association of anxiety with noise exposure, a desensitization program is usually appropriate.
One therapy program requires the child to produce a range of different sounds in a play activity area. If fear of a specific situation has become established, it is important to gradually desensitize the child, with time and care.
Whether this is to do with changing the excitation patterns in the auditory system, or whether it gives people more control over their anxiety (or both), is not yet clear.
There is no possibility of damage to the hearing mechanism through use of sound generators. This is not to raise the profile of the hearing sensitivity, but to keep a note of changes in behavior or reaction to sounds while the noise-generators are being used. As the impact of hyperacusis is much less now, there is a tendency for people to be reluctant to fill in the form consistently at this stage. In some cases hyperacusis occurs due to damage to the cochlea in which an abnormal increase in loudness as perceived in the auditory pathways occurs. The physical occurrence of pain with noise exposure should be acknowledged, even though the condition may be maintained by anxiety.
Most adults report that over about one year to eighteen months of noise-generator use, their sensitivity to sound is much more normal. The ear mold and device must be comfortable and secure so that it is realistic to build up the daily hours of use.
If a child is not able to communicate detection of the sound, maskers should be fitted at the just-audible output for another normally hearing person. If your child has different hearing loss levels in each ear, choose the handout that is the same as his better hearing ear. The final Preschool SIFTER (in Spanish) can be used to provide insights to the child’s new teacher in the following fall. This sensitivity to sound is due to cochlear recruitment and only appears in persons with hearing loss. Assume that any noise which is seen to be aversive to the child, is also uncomfortable, and work to break down the fear association. However if there is a wide range of sound sources and situations a more proactive approach is needed. Family members can share this tool with their child’s school team as a means of monitoring his or her performance throughout the school year. Persons with normal hearing who have abnormally strong reactions to sound that is not loud cannot have recruitment. A clinical psychologist can develop a program of behavioral desensitization, but the following suggestions can be used by everyone.
Occasionally the hyperacusis is reported from one ear in which case only that side needs to be fitted.
That said, persons with hearing loss can also be very sensitive to sound without having recruitment.

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