How does one test for hyperacusis in children, and what are the recommended strategies?
Decreased sound tolerance is a relatively frequent complaint in children. In most instances the issue is ignored and considered a temporary problem. Sometimes the use of ear protection is advised, or help from a psychologist is suggested. During recent years, the problem of decreased sound tolerance has attracted more attention. As a result, its two main components have been identified: hyperacusis, defined as an abnormally strong reaction to sound that occurs within the auditory pathways, and misophonia, defined as an abnormally strong reaction of the autonomic and limbic systems resulting from enhanced connections between the auditory and limbic systems.
It is important to realize that even though hyperacusis can be the only problem, it is frequently associated with tinnitus. Hyperacusis can be also a part of a complex medical diagnosis. In that case, the involvement of a physician is recommended. Careful identification of different components of decreased sound tolerance is crucial in choosing proper treatment strategies.
The diagnostic tools depend on the age of the child and consist of: 1) detailed interview of the child, 2) interview of the parent /guardian, and 3) evaluation of the speech and pure tone loudness discomfort levels (LDL). LDLs can be obtained from children as young as 6 years.
With children, the most significant information for diagnostic purposes comes from the detailed interview. By finding out which sounds and in which situations discomfort occurs, it is possible to assess the presence and extent of hyperacusis.
It is crucial to recognize if reactions to a given sound are similar even in different surroundings, as this helps to differentiate between hyperacusis and misophonia. The interviewer has to be friendly, sensitive and nonjudgmental. Questions have to be asked properly, adjusting language levels to a patient's abilities, and using parables. There is a need for careful comparison of the direct statements of the child and those of parents.
We are very successful in treating children with hyperacusis using Tinnitus Retraining Therapy (TRT). This has as a part of the treatment protocol, using gradual desensitization with proper use of sound aimed at hyperacusis.
There is a separate protocol for misophonia. It involves systematic exposure to sounds, associated with a pleasant situation, with gradually increasing sound levels. In most cases the use of sound generators is advisable. To our surprise, children are very compliant, including use of sound generators, and the progress of their improvement is rapid. Many children with decreased sound tolerance overuse earplugs and earmuffs, which actually enhances the problem. With the progress made as a result of TRT, including the protocol for misophonia, children are gradually encouraged to stop using overprotection of the ears.
We treated with TRT a number of children with tinnitus and/or hyperacusis. The results were presented during this year meeting of Association for Research in Otolaryngology, Florida, and 7th International Tinnitus Seminar, Fremantle, Western Australia, March 2002. Results are excellent, and generally children are doing extremely well with TRT (similar findings from UK).
See: Jastreboff, M.M., Jastreboff, P.J. Hyperacusis. Published in Audiology Online, 6-18-2001.
Pawel J. Jastreboff, Ph.D.,Sc.D, is a Professor of Otolaryngology and Director of Tinnitus & Hyperacusis Center, Department of Otolaryngology at Emory University. Margaret M. Jastreboff, Ph.D. is an Associate Professor of Otolaryngology and Director of Academic Affairs at the Department of Otolaryngology, EmoryUniversity.