Hyper-hearing, Hyperacusis or Sensitive Hearing and Bérard AIT
Rosalie Seymour, SLP/A, Bérard AIT Practitioner and Bérard Professional Trainer
This condition is poorly understood by audiologists in my experience: there is a greater appreciation of the condition by Bérard AIT Practitioners than by audiologists, with a few exceptions.
It is not always clear whether it is an exaggerated response by the nerves of hearing or whether it is more appropriate to describe it as an exaggerated response by the listener – in the sense of the …” if a leaf falls in the forest and there was nobody to hear it, was there a sound?..” debate. There do seem to be various conditions, and maybe different cases and different ways to treat. For example:
- There is a condition of ‘exaggerated subjective response of loudness’ by the ear / the listener who has a tested audiogram ‘within normal limits” i.e. between 0 to 20 dB, but finds certain sounds abrasive / painful / irritating.
- There is a condition of raised sensitivity as revealed by a hearing threshold above the 0 dB line, sometimes called “bionic hearing” on certain frequencies or even on all frequencies. Levels of -40 dB have been recorded, although most audiometers only test up to – 10 dB. Such people experience everyday sounds at a much louder volume than those with ‘normal’ hearing levels would, so are more prone to experiencing sounds as painful / annoying / distracting / irritating.
- Everyone can experience painful hearing. The threshold for pain is normally reached around 120 to 140 dB. The area between the hearing threshold (0 to 20 dB) and the pain threshold (usually 120 to 140 dB) is called the person’s “Dynamic Range”. That is the range of loudness between threshold and pain in which the ear / person can hear, and process sound for meaning.
- There is a mechanism for protecting the hearing called the “Acoustic Reflex”, which comes into action when sounds reach the loudness of 80 to 95 dB (it varies per person). The tympanic and stapedius muscles of the ossicular chain (the little bones of the middle ear) clench tightly, impeding the passage of sound to the inner ear, and thereby protecting the inner ear’s delicate cells from damage caused by loud sounds. One can experience sounds at this level as ‘loud’ even ‘too loud’ but not painful.
- There is the kind of painful hearing described for people with hearing loss, as tested in the moderate to profound range – usually from 50 to 90 dB losses or greater, with cochlear involvement, or inner-ear / nerve hearing loss involved. These people need sounds made louder before they can begin to hear them, but when they do begin to hear – at threshold – the sound is immediately also painful. When the nerves of the cochlea are affected the pain threshold is reached more quickly, For example, a person begins to hear the frequency at 60 dB but experiences pain at 65 dB. This means their Dynamic Range is only 5 dB as compared to the normal 100 dB or thereabouts. This is what makes adjusting to hearing aids so difficult.
All of these conditions involve poor auditory processing, but are these conditions essentially similar in origin? We know that they are neurological (cochlea to brain) not peripheral (outer ear and middle-ear). Although Dr. Bérard said that in the case of a spasmed acoustic reflex, the little muscles of the middle ear go into spasm, which can cause the pain of painful hearing. This has not been researched to date, but could be an interesting study. The causes of hyper-hearing, hyperacusis or sensitive hearing or painful hearing are various, and not clearly known.
- It is known that nerve damage can cause painful hearing in brain damage or cochlear damage.
- It has been described how nerve hearing loss can cause painful hearing.
- It is known that hypersensitivity in general (sensory integration issues) can also be associated with painful hearing – if a child is hyper-sensitive in one sensory domain, it is likely they will also be hypersensitive in other sensory domains, since it is the processing organ not the sense-organ that is operating defectively.
- Nutritional problems, and neurobiological differences, can be at the root of many painful hearing cases. It has been documented that low magnesium levels especially can lead to hyper-sensory problems, and that supplementation and even mega-dosing with Magnesium and Vitamin B6, together with zinc and calcium, can over a period of one to three months cause a pleasing reduction in the pain of painful hearing.
Treatment of Hyper-hearing, Hyperacusis or Sensitive Hearing with Auditory Integration Training
- Metabolic assessment and supplementation as mentioned above can be very effective for some. This is a long-term treatment.
- Bérard Auditory Integration Training has proven itself effective for many cases and types of hyper-sensitive hearing, with lasting benefits being documented.
- The benefits of Bérard AIT alone, if there is a metabolic issue left untreated, could be limited.
- The implication is that when there are sensory processing issues, a neurobiological assessment should always be performed to determine whether the metabolic problem that caused the issue in the first instance is still active.
Ear Protectors and Hyper-hearing, Hyperacusis or Sensitive Hearing
There is a tendency for some with painful hearing to wear ear protectors. This has been strongly disadvised by Dr. Bérard, since it exacerbates the problem. The relief is short-term but the negative effects lasting.
However, when a person in the throes of treatment has to expose themselves to sounds that cause them great distress, it might be a cautious and very brief help to them to allow the wearing of protectors, noting that doing so must be for very brief periods only, and is likely worsening the situation.