Hyperacusis

Specialty: Otolaryngology.

• Hypersensitivity to sound
• intolerance to everyday noises
• mild pain reliever
• phonophobia of auditory origin

Why it occurs

• Dysfunction or paralysis of the facial nerve in its branch to the stapes muscle, compromising the stapedial reflex
• Vestibular migraine with alteration of auditory sensory processing at the level of the brainstem
• Chronic exposure to harmful levels of noise that unbalances the efferent auditory pathways
• Ménière's disease due to decompression and mechanical distortion of the membranous labyrinth
• Mild head injury with persistent concussion syndrome

Initial workup

Complete liminal tonal audiometry with determination of hearing discomfort levels (UCL) at all frequencies, tympanometry with study of ipsilateral and contralateral stapedial reflex thresholds, and brain and posterior fossa MRI with emphasis on the path of cranial nerves VII and VIII if a neurovascular conflict or space-occupying mass is suspected.

Standard management

• Sound habituation therapy through the use of broadband white noise generators — more effective than prolonged hearing isolation that exacerbates system gain
• Active hearing protectors with selective attenuation filters — for unavoidable noise situations
• Drugs that modulate neuropathic pain such as pregabalin (50-75 mg orally every 12 hours, individually adjusted if there is a severe associated pain component) or anxiolytics if the symptom generates panic attacks.