Which of these do you hate?
- Plates clattering
- Pens clicking
- Motors idling
- Ice rattling
- Bass thumping
- Paper crinkling
- Coins jingling
All of them?
Diagnosis: Hyperacusis.
Say what?
Hyperacusis and misophonia are often confused. Both are sometimes lumped under the umbrella heading of “decreased sound tolerance.”
And in both cases, coping strategies are similar: Judicious use of earplugs or ear protection, and avoidance of situations that will expose you to the noise. For the Average Joe — and even for a doctor or audiologist — it’s hard to tell them apart.
But conflating hyperacusis and misophonia is akin to saying that a sprained ankle and an ingrown toenail are the same. Both involve a lower extremity and both make you limp.
Hyperacusis and misophonia are completely different conditions.
Hyperacusis is noise-induced pain, usually developing from an injury caused by excessive noise exposure. Ordinary sound is often perceived so loud as to be felt as pain. It’s often accompanied by other results of trauma — the pressure feeling called aural fullness, the ringing in the ears called tinnitus and a constant burning pain in the ear canal.
Misophonia is noise-induced rage, an instantaneous reaction, probably hard-wired and possibly inherited. It has nothing to do with the loudness or frequency of a sound, and everything to do with the meaning or context. A trigger sound, even a soft one, causes anger, rage or panic. Triggers can also be visual or olfactory.
Both are poorly understood and under-researched. To encapsulate the difference in one quick soundbite? Hyperacusics hate loud sounds; misophones hate soft sounds.
A more nuanced list of key differences between misophonia and hyperacusis
CAUSE
H: Often a physical injury or illness — excessive noise exposure, a blow to the head, Lyme Disease, floxie poisoning, ME/Chronic Fatigue.
M: Appears to be hard-wired and inherited.
ONSET
H: Usually after acoustic overexposure, injury or illness.
M: Usually suddenly in late childhood or early adolescence.
WHAT A BAD NOISE FEELS LIKE IN THE MOMENT
H: Pain in the ear canal.
M: Rage, anger, panic.
ACCOMPANYING SYMPTOMS
H: Aural fullness or pressure, tinnitus (ringing in ears), pain in ear canal. These symptoms often are confined to the ear (though they can involve the scalp, jaw and neck). They usually manifest with a delayed reaction, with symptoms lingering for days, weeks or months.
M: Racing heart, sweaty palms, tight chest. These symptoms often involve the whole body. They usually come on instantaneously, dissipating after the trigger noise ends.
LOUDNESS DISCOMFORT LEVEL (LDL) TEST
H: Results are U-shaped, usually lowest in the high/low frequencies and highest in the mid-frequencies. Threshold of loudness discomfort is usually well below 100 dB and can be 0 dB in severe cases.
M: Results mirror the shape of the audiogram curve. For someone without hearing loss, the line is straight across. Threshold of loudness discomfort is usually well above 100 dB, close to 120 dB or higher.
HOW IT BEHAVES OVER TIME
H: Often improves slowly over weeks, months or years; then worsens immediately with noise exposure.
M: Often stays stable or worsens over a lifetime.
THE LOUDER, THE BETTER?
H: No. Louder means additional ear pain.
M: Yes. Louder means more ability to drown out triggers. However, for some decibel does not change it one is triggered – though, it is important to note that louder does not cause more “pain”.
EXAMPLE: THE PARADE PASSES BY — SIRENS, HORNS AND 76 TROMBONES
H: Months of lingering fullness, ringing, sensitivity and pain.
M: Depends whether or not it is a trigger
For more on hyperacusis, see hyperacusisresearch.org and facebook.com/hyperacusisresearch.
