hyperacusis hyperacusis hyperacusis is the increased sensitivity to sound and a low tolerance for environmental noise. definitions of hyperacusis can vary significantly; it can refer to normal noises being perceived as: loud, annoying, painful, fear-inducing, or a combination of those, and is often categorized into four subtypes: loudness, pain, annoyance, and fear. hyperacusisother nameshyperacousisspecialtypsychiatry, neurology, otolaryngologydifferential diagnosissensory processing disorder, autismfrequency1 in 50,000 it can be a highly debilitating hearing disorder. hyperacusis is often coincident with tinnitus. the latter is more common and there are important differences between their involved mechanisms. little is known about the prevalence of hyperacusis, in part due to the degree of variation in the term's definition. reported prevalence in children and adolescents ranges from 3% to 17%. while there are no exact numbers, several people have comitted suicide due to the severe consequences of the disease. this includes musician jason diemilio (azusa plane). a hyperacusis sufferer in belgium took his life in 2009, after years of struggling with catastrophic hyperacusis and tinnitus. a local government in belgium made a short film based on this person's life, to warn others from the dangers of hyperacusis and tinnitus. signs and symptoms in hyperacusis, the symptoms are ear pain, annoyance, distortions, and general intolerance to many sounds that most people are unaffected by. crying spells or panic attacks may result from the experience of hyperacusis. it may affect only one or both ears. hyperacusis can also be accompanied by tinnitus. hyperacusis can result in anxiety, stress and phonophobia. avoidant behavior is often a response to prevent the effects of hyperacusis and this can include avoiding social situations. loudness hyperacusis hyperacusis is most often characterized by a sensitivity to sound, where the perception of loudness is much greater than for a typical person; it is often associated with certain volumes and/or frequencies. hyperacusis can occur in children and adults, and can be either "short-term" in a duration of weeks to less than a year before recovery, or, less-commonly, "long-term", spanning years and in some cases becoming permanent. sensitivity is often different between ears. noxacusis (pain hyperacusis) in some instances, hyperacusis is accompanied by pain, which is known as noxacusis. noxacusis is characterized by pain resulting from sounds, often initiated at certain volumes or frequencies; pain can be immediate or delayed, and sometimes persists for an extended period of time following exposure. pain can be acute or chronic, and is often described as stabbing, burning, acid, or nerve pain, and is sometimes equated with the pain of a root canal or a broken tooth. loudness discomfort level (ldl) the threshold of sound at which discomfort is initially experienced; measured in decibels (db). setback after a period of some relief from symptoms, discomfort resumes; often resulting from exposure to sound, or, in some cases, ototoxic medications or injuries. setback prevention is an important focus among those affected. associated conditions some conditions that are associated with hyperacusis include: acoustic shock adverse drug reaction anxiety asperger syndrome attention deficit hyperactivity disorder autism spectrum bell's palsy depression endolymphatic hydrops fetal alcohol spectrum disorder hypothyroidism lyme disease migraine ménière's disease temporomandibular joint disorder trigeminal neuralgia multiple sclerosis noise-induced hearing loss posttraumatic stress disorder severe head trauma sjögren syndrome superior canal dehiscence syndrome (scds) systemic lupus erythematosus (sle) tay–sachs disease tinnitus tonic tensor tympani syndrome visual snow williams syndrome causes the most common cause of hyperacusis is overexposure to excessively high decibel (sound pressure) levels. some affected people acquire hyperacusis suddenly as a result of taking ear sensitizing drugs, lyme disease, ménière's disease, head injury, or surgery. others are born with sound sensitivity, develop superior canal dehiscence syndrome, have had a history of ear infections, or come from a family that has had hearing problems. bell's palsy can trigger hyperacusis if the associated flaccid paralysis affects the tensor tympani, and stapedius, two small muscles of the middle ear. paralysis of the stapedius muscle prevents its function in dampening the oscillations of the ossicles, causing sound to be abnormally loud on the affected side. age may also be a significant factor . some psychoactive drugs such as lsd, methaqualone, or phencyclidine can cause hyperacusis. an antibiotic, ciprofloxacin, has also been seen to be a cause, known as ciprofloxacin-related hyperacusis. benzodiazepine withdrawal syndrome is also a possible cause. there are diametrically opposing views on avoiding overuse of hearing protection and silence. audiologists may advise against using hearing protection in normal sound environments, claiming it can cause or worsen hyperacusis. a study showed that a patient advised to avoid silence, avoid overprotection, and use background sounds showed improvement in three months. in contrast, healthy hearing, a clinic directory run by audiologist mandy mroz, claims that a "myth in the field is that 'overprotection' worsens people" referencing a two week study showing a temporary threshold decrease and also claims that "quiet promotes healing" while "some cases, however, worsen with sound therapy". preliminary research showed that people with hyperacusis can experience an exacerbation of their symptoms when not adequately protecting themselves against loud sounds. an acoustic shock can also occur after exposure to an unexpected moderately loud to loud noise, even if this does not necessarily result in permanent cochlear damage. neurophysiological mechanisms