Since the summer of 1997, unusual cases of hyperacusis have contacted
my clinic to report symptoms that stray outside the 'regular' pattern
of hyperacusis. One of these variations involves strong negative
reaction to soft sounds, in particular, sounds associated with eating,
breathing, speaking, or lip smacking. The first few cases were
spaced out over a wide span of time, and I wondered at the signficance
of the reported issues. Over time, however, it has become crystal
clear that this condition affects more than only a few people.
The onset of this type of hyperacusis often appears to take place in
childhood years, frequently around puberty onset, with a range variation
of 10 + years. The youngest child that I have evaluated was six
years old, and the latest onset appears to take place in the 20s.
Most of the reported sufferers are girls, about 70 % to date, and the
rest boys. There are often a few other concerns about the patients,
occasional ADD/HD or mild obsessive compulsive disorder, however, as
a group they are high functioning, capable individuals. No remarkable
medical history presents itself in the reporting of the patients as a
whole group. As a matter of fact, they tend to do well in school
as a general rule, academically, enjoy social outings and friends, and
participate in many different activities.
Since 1997, I have evaluated about 90 of these cases personally, and consulted on another 215 cases from far away including other countries. Clearly, this is a rather small subset of hyperacusis, yet, an important one.
It has been my experience to date that most of these individuals bring
their concerns to their physicians and are mostly routed to the mental/emotional
health providers for therapy. Once in a while an audiologist will
conduct a hearing test, but as most of these cases exhibit perfectly
normal hearing, this avenue closes. The vast majority of the patients
who have contacted me so far have seen psychiatrists who attempt to diagnose
an emotional disorder and most of the patients are then prescribed various
chemicals such as anti-obsessive drugs, anti depressants, anti anxiety
drugs, or other types of psychotropic medications. Most of these
medications have negative side effects and often have not been well documented
for side effects in children, effects on the developing brain, and so
forth.
Noises that are identified as bothersome or extremely annoying most
often relate to noises associated with the mouths or noses of other people. Biting,
chewing, forks clicking on plates or teeth, tongues licking lips, lips
smacking when opening or shutting, sssss sounds or other high frequency
sounds, fingernail biting, or breathing sounds, can send these patients
through the roof, out the door, into their rooms, and into seclusion.
Emotional reactions are closely related to this syndrome: victims may
cry, yell, strike out, retreat, scream, withdraw, abuse others verbally
or physically, in an effort to remove the negative stimulation. One
patient described these very soft sounds as akin to 'fingernails on a
million blackboards'. There is an irresistable urge to remove oneself.
One obvious symptom is the loss of the family dinner table tableau: in families where young people have this syndrome, this daily event is severely compromised. Ten year olds eat dinner alone in another room, teen agers take plates to the basement, and so forth. Just seeing another person 'prepare' to lift the fork to the mouth can set off a severe reaction.
