How is hyperacusis diagnosed and treated?

1. Clinical History and Examination
   • A detailed medical and hearing history helps identify risk factors such as noise exposure, anxiety disorders, or ear trauma.
   • The doctor may examine the ear and facial nerve function to rule out related disorders like Bell’s palsy or otitis media.
2. Audiometric Testing
   • Pure-tone audiometry: Determines the softest sound levels a person can hear (hearing threshold).
   • Uncomfortable Loudness Levels (ULLs) or Loudness Discomfort Levels (LDLs): Measures the volume at which sounds become uncomfortable.
     • Patients with hyperacusis typically have LDLs of ≤77 dB, compared to about 100 dB in normal listeners.
3. Questionnaires
   • Hyperacusis Questionnaire (HQ): Evaluates emotional, attentional, and social impacts of sound sensitivity; scores ≥22–28 indicate presence of hyperacusis.
   • Other tools: GAD-7 (for anxiety), PHQ-9 (for depression), and MASH (Multiple Activity Scale for Hyperacusis) help assess psychological components.
4. Imaging (If Needed)
   • MRI or CT scans may be ordered when hyperacusis is linked to facial paralysis, acoustic neuroma, or middle ear abnormalities.
5. Emerging Methods
   • New psychoacoustic tests use natural sounds instead of pure tones for diagnosis, providing more patient comfort and accuracy.

Treatment and Management

1. Sound Therapy (Desensitization)
   • Gradual exposure to low-level sounds using sound generators or environmental noise helps retrain the auditory system to tolerate normal sound intensities.
2. Cognitive Behavioral Therapy (CBT)
   • CBT helps patients reduce anxiety and emotional distress from sound sensitivity, improving quality of life.
3. Tinnitus Retraining Therapy (TRT)
   • Combines sound therapy and counseling to recondition the brain’s response to noise and reduce auditory overstimulation.
4. Medication
   • No drugs specifically cure hyperacusis, but medications may help manage associated conditions like anxiety, depression, or migraine.
5. Protection and Lifestyle Adjustments
   • Patients are advised to avoid overusing earplugs, as silence can worsen sensitivity. Instead, moderate sound exposure and relaxation practices are encouraged.
6. Surgery (Rare Cases)
   • In severe or nerve-related cases, surgical repair of the stapedius muscle or oval window reinforcement may be performed, though this is uncommon.