Murray Grossan, MD, ear, nose and throat specialist, Cedars-Sinai Medical Center, Los Angeles. GrossanInstitute.com
Bottom Line: When that pencil tapping or loud restaurant is driving you crazy, here’s how to end the irritation…
Whether it’s a crying baby, a loud TV commercial or the background clatter in a restaurant, noise seems to bother me much more now than it used to. Is this normal with age? Or could something else be causing this irritation?
Sensitivity to noise is not typically due to aging. The condition is called hyperacusis, and it’s characterized by an exaggerated response to ordinary sounds that are tolerated well by others. Often the most disturbing sounds are sudden high-pitched noises such as alarms, which annoy most people but could cause an extreme reaction in those with hyperacusis, the clanging of silverware and dishes, children's screams and clapping. The strength of symptoms can vary widely—from mild decreased sound tolerance…to a strong dislike of specific sounds, such as dripping water or someone chewing, that results in extreme irritation or even anger (misophonia)…to fear of sound that can cause avoidance of many situations that could be too noisy (phonophobia). Hyperacusis may be a symptom of another disease or condition including depression or anxiety…post-traumatic stress disorder (PTSD)…Lyme disease…Ménière's disease…noise-induced hearing loss…damage to the ear…head injury…tinnitus…temporomandibular joint dysfunction (TMJ), which may cause inflammation in the Eustachian tube (often called the auditory tube) in the middle ear…or migraine headaches. But it can also occur with no underlying condition. Besides sensitivity to sound, other symptoms can include difficulty concentrating, following conversations, performing work tasks, relaxing and/or sleeping…and anger, irritability, anxiety and depression. If you are concerned about your symptoms, see an audiologist for the assessment, diagnosis and management of hyperacusis. An audiologist will do a physical exam and take a medical history as well as give you a hearing test called an audiogram. You may be referred to an otolaryngologist, psychiatrist or psychologist or another doctor in some other medical specialty, depending on the findings. Treatment should include help for any underlying condition, such as TMJ or migraine headaches, which may solve the problem, but also may include counseling designed to help the patient better cope with his/her problem. (It’s important not to get stressed by sounds because this only makes the condition worse.) Acoustic therapy, performed by an audiologist, can decrease a patient's sensitivity to sounds and teach him to view sound in a more positive light. Acoustic therapy can be used in conjunction with other treatments for any underlying condition as well as when there’s no apparent cause. In one approach, the patient wears a small device that looks like a hearing aid, which produces steady, 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. In most cases, the treatment is successful, but it can take anywhere from three months to two years for improvements to be made. Depending on the cause, treatment for hyperacusis may also involve cognitive behavioral therapy, which helps with depression, anxiety, insomnia and PTSD. Some coping strategies to try on your own: Practice listening to sounds that bother you at a low volume, then gradually increase the volume and duration over time…add some white noise to your environment—run a fan, a white noise machine or install a white noise app on your cell phone…and/or wear noise-canceling headphones or earbuds. (Note: The constant use of headphones/earbuds is not advised as they can alter the brain's calibration of loudness and may teach the brain to further restrict its comfort range.) Sometimes hyperacusis can resolve on its own without any treatment.