FS101 - Audiological Management of Hyperacusis

Abstract:
Hyperacusis is one of the major complaints associated with the auditory system. The underlying etiology for hyperacusis not only includes some sort of insult to the auditory system but also the psychological impact that influences the sufferer’s quality of life. This presentation will explore neurologic, psychologic, and oto-audiologic contributing causes for this condition. The therapeutic approaches for hyperacusis including addressing the factors of sensation, emotion and cognition will be addressed. These include use of sound therapy, extensive counseling and application of CBT in the intervention program. Our research on hyperacusis in the autism population will be shared with the audience.

Summary:
Hyperacusis is an over-reactive response to sounds that may not be perceived as loud by typical individuals. Hyperacusis has a sensory as well as a psychologic component. Many clinicians may find the various manifestations and co-occurring conditions associated with patients who present with sound sensitivity disorders, particularly hyperacusis, to be variable and confusing. Hyperacusis is indeed a complex phenomenon, as it can occur across a wide range of patient populations, and in a broad spectrum of age groups. Oftentimes it is hard for audiology professionals to clearly define the type of hyperacusis a patient may have, as well as identify an efficacious approach to treating the symptoms of the condition in order to improve the individual’s overall quality of life. The purpose of this presentation is to help practicing audiologists more appropriately identify and subsequently treat patients suffering from hyperacusis in a more informed and individualized manner, using current research literature as the guide. The three factors of sensation (what the patient perceives), emotion (how the patient reacts) and cognition (the way the patient processes obnoxious acoustical signals) in the management of hyperacusis will be explored.

The classification of different clinical presentations of hyperacusis can be broken down into four distinct subtypes (loudness, annoyance, fear, and pain hyperacusis, respectively), according to Tyler and colleagues. Defining these subtypes, as well as examining and differentiating between other decreased sound tolerance disorders will be the function of the beginning of this featured session. From there we will examine the prevalence data of hyperacusis and describe its potential causes. An overview of current research regarding hypotheses of the neurological underpinnings of hyperacusis will follow, which will include the description of central gain theory, the auditory-limbic system, and the medial olivocochlear efferent system and its potential involvement in symptoms of hyperacusis. Upon completing this description, we will move on to identifying the multitude of clinical pathologies that hyperacusis has been known to present with, including Meniere’s disease, insular lobe lesion, middle cerebral aneurysm, Creutzfeldt-Jakob disease, Bell’s palsy, Lyme disease, Semicircular Canal Dehiscence Syndrome, and ASD (for which we present some of our own research data).

Upon covering some of the scientific bases for hyperacusis and its co-occurrence with other conditions, we will move to the clinical management of this disorder. Evaluation strategies will be discussed, including loudness discomfort level (LDL) measurement and subjective assessment. From there clinical management of hyperacusis will be reviewed, addressing the factors of sensation, emotion, and cognition. The presentation will provide clinical information related to patient education, psychological counseling, and sound therapy. Medical and surgical studies of hyperacusis intervention will also be briefly reviewed. Discussion will be encouraged in regard to each of these cases, and/or any of the presented material. It is our goal that practitioners in this session will walk away with a greater understanding of hyperacusis from both a scientific and clinical perspective, and will be more adept at helping patients suffering from this condition going forward.

Brief Summary of Clinical Takeways:
Hyperacusis is not Recruitment.
Hyperacusis is Manageable.