Hyperacusis

Sound sensitivities in children and teens present in many ways and can be caused by a variety of factors. From the 6-year-old with hands over his or her ears at a birthday party, to the teen who cannot tolerate high-pitched sounds or attend band practice following a concussion, the inability to tolerate every day sounds in one’s environment can cause daily distress for child and family.

Difficulty tolerating sounds at a volume or pitch that would not typically be bothersome to others is known as hyperacusis. Hyperacusis is common in children of preschool age, and it usually goes away with maturation. In some children, particularly those with neurodevelopmental issues, the problem can persist. Hyperacusis can cause anxiety and the desire to avoid certain places or activities.

According to research, the incidence of hyperacusis in children is between 3.2 percent and 17.1 percent. Problematic sounds for younger children tend to be loud and unpredictable, such as the hand dryer or self-flushing toilets in public restrooms, or the vacuum or blender at home. For a hyperacusic child, the school day can be ruined by a fire drill. For children with hyperacusis acquired later. either as a result of a health condition or after some type of trauma, the clanging of silverware on plates, certain music, riding the subway, or hearing their dog bark may cause discomfort and even pain.

Young children, or children who have developmental or sensory processing issues may block their ears in noisy environments, become fearful of using the public restroom, or refuse to go to indoor gym class, for example. They may become very upset when they encounter noise that bothers them. This type of hyperacusis may be related to sensory overload and an inability to filter unimportant auditory stimuli.

Hyperacusis has a variety of causes such as noise exposure, head trauma, migraine headaches, and post-traumatic stress. It often co-exists with hearing loss or tinnitus. It is more common in children with autism. This type of hyperacusis may be related to overactivity of auditory neurons in the brainstem auditory pathways, causing a perception of the sound as much louder than it really is.

A child must be at least 5 years old to have a hyperacusis evaluation. A hyperacusis diagnosis is based on the patient’s reported symptoms. At Boston Children’s Hospital, your child will be seen by an audiologist who will interview you and your child about the sounds that bother them, their behavior when they encounter or try to avoid those sounds, and any related health history. Next, they will perform a comprehensive hearing test to rule out hearing loss or dysfunction of the middle or inner ear. Finally, the audiologist will make suggestions to help your child and family cope with your child’s sound sensitivities, and if symptoms or test findings suggest and underlying medical problem, will refer your child to a Boston Children’s ear, nose, and throat physician (otolaryngologist).

Hyperacusis can be treated through cognitive behavioral therapy, tinnitus retraining therapy, or if the hyperacusis has an underlying treatable cause, the appropriate medical treatment.

The Boston Children’s Tinnitus and Decreased Sound Tolerance Program is a resource for children who are significantly distressed by hyperacusis. Through an individualized approach with an audiologist using counseling and sound therapy techniques based on tinnitus retraining therapy, a child and family can learn ways to reduce the effects of hyperacusis on daily life, and to facilitate an improvement in the child’s ability to tolerate sound. When a child has hyperacusis that is debilitating, cognitive behavioral therapy in conjunction with tinnitus retraining therapy techniques may be recommended.

If you are seeking help for your child with hyperacusis, the first step is to schedule an appointment with a Boston Children’s audiologist by calling 617-355-6461.