Editing Hyperacusis (section)

==Management and treatment==
There are currently no evidence-based guidelines regarding the treatment of patients with hyperacusis. The majority of audiologists report insufficient formal education in this area, likely due in part to the current lack of consensus in the literature regarding definitions and treatment of hyperacusis.<ref>{{Cite journal |last1=Jahn |first1=Kelly N. |last2=Koach |first2= Chelsea E. |date=2023-11-02 |title=Hyperacusis Diagnosis and Management in the United States: Clinical Audiology Practice Patterns |url=http://dx.doi.org/10.1044/2023_aja-23-00118 |journal=American Journal of Audiology |volume=32 |issue=4 |pages= 950–61 |doi=10.1044/2023_aja-23-00118 |pmid=37917915 |s2cid=264972147 |issn=1059-0889|pmc=11001428 }}</ref>

=== Avoidance and hearing protection ===
[[File:Hyperacusis patient wearing ear protection.jpg|thumb|Hyperacusis patient wearing ear protection]]
Setback prevention and reduction of pain symptoms are high priorities among those with hyperacusis and noxacusis, which is often managed through a combination of controlling the environment so as to avoid loud sounds, [[soundproofing]], and wearing hearing protection, such as [[earplug]]s and safety [[earmuffs]].<ref>{{Cite web |date=January 5, 2023 |title=8 Ways to Manage Migraine Sound Sensitivity — Besides Shushing Others |url=https://www.migraineagain.com/8-ways-to-manage-migraine-sound-sensitivity-besides-shushing-others/ |website=migraineagain.com}}</ref><ref>{{Cite web |last=hyperacusiscentral |date=2023-04-19 |title=Silence is Bliss With a Few Home Adjustments - Hyperacusis Central |url=https://hyperacusiscentral.org/silence-is-bliss-with-a-few-home-adjustments/ |access-date=2024-08-25 |website=hyperacusiscentral.org |language=en-GB}}</ref> Preliminary research has shown that individuals with pain hyperacusis can experience an exacerbation of their symptoms when not adequately protecting themselves against loud sounds.<ref name= "Pollard-2019" />

There are diametrically opposing views on avoiding overuse of hearing protection and silence. Some audiologists may advise against using hearing protection in normal sound environments, claiming it can cause or worsen hyperacusis. This is based on a study in healthy volunteers and not individuals with preexisting loudness or pain hyperacusis.<ref>{{Cite journal |last1=Formby |first1= C. |last2=Sherlock |first2=L. P. |last3=Gold |first3=S. L. |date=July 2003 |title=Adaptive plasticity of loudness induced by chronic attenuation and enhancement of the acoustic background |url=https://pubmed.ncbi.nlm.nih.gov/12880017 |journal= The Journal of the Acoustical Society of America |volume=114 |issue=1 |pages=55–58 |doi=10.1121/1.1582860 |issn=0001-4966 |pmid= 12880017|bibcode= 2003ASAJ..114...55F }}</ref>

=== Sound therapy ===
Sound therapy is sometimes recommended for those with hyperacusis, though there is limited evidence supporting its use.<ref name="Sound therapy current recommendations">{{Cite journal |last= Kalsoom|first=Nighat|date= 2024|title= Current Recommendations for the Use of Sound Therapy in Adults with Hyperacusis: A Scoping Review
|journal=Brain Sciences|volume=14|issue= 797|page=797 |doi=10.3390/brainsci14080797|doi-access=free |pmid=39199489|pmc=11352218 }}</ref> Its application among those with pain (noxacusis) should be used with caution. [[Tinnitus retraining therapy]], a treatment originally used to treat tinnitus, uses broadband noise to treat hyperacusis. [[Pink noise]] can also be used to treat hyperacusis. By listening to broadband noise at soft levels for a disciplined period of time each day, some patients can rebuild (i.e., re-establish) their tolerances to sound.<ref name= "pmid25478787" /><ref>{{Cite journal| vauthors=Lindsey H |date=August 2014 |title=Help for Hyperacusis: Treatments Turn Down Discomfort |journal=The Hearing Journal |language=en-US |volume=67 |issue=8 |pages=22 |doi=10.1097/01.HJ.0000453391.20357.f7 |issn= 0745-7472 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Formby C, Hawley ML, Sherlock LP, Gold S, Payne J, Brooks R, Parton JM, Juneau R, Desporte EJ, Siegle GR |display-authors=6 |title=A Sound Therapy-Based Intervention to Expand the Auditory Dynamic Range for Loudness among Persons with Sensorineural Hearing Losses: A Randomized Placebo-Controlled Clinical Trial |journal=Seminars in Hearing |volume=36 |issue=2 |pages=77–110 |date=May 2015 |pmid=27516711 |pmc=4906300 |doi=10.1055/s-0035-1546958}}</ref><ref>{{Cite book|title=Hyperacusis and Disorders of Sound Intolerance Clinical and Research Perspectives| vauthors= Fagelson M, Baguley DM |publisher=Plural Publishing |year=2018 |isbn=978-1-94488-328-7 |pages=C15, C16}}</ref> More research is needed on the efficacy of sound therapy techniques when hyperacusis is the primary complaint, rather than a secondary symptom, indicating that "no strong conclusions can be made" about its efficacy at this time.<ref name=pmid29312994/> Importantly, individuals with pain hyperacusis are more likely than individuals with loudness hyperacusis to report worsening of their condition after the use of sound therapy.<ref name="Williams-2021b" />

=== Cognitive behavioral therapy ===
Another possible treatment is [[cognitive behavioral therapy]] (CBT), which may also be combined with sound therapy.<ref name= "Baguley, 2003"/><ref>{{cite journal |vauthors=Aazh H, Moore BC, Lammaing K, Cropley M |title=Tinnitus and hyperacusis therapy in a UK National Health Service audiology department: Patients' evaluations of the effectiveness of treatments |journal= International Journal of Audiology |volume=55 |issue=9 |pages=514–22 |date=September 2016 |pmid=27195947 |pmc=4950421 |doi= 10.1080/14992027.2016.1178400}}</ref> However, randomized controlled trials with active control groups are still needed to establish the effectiveness of CBT for hyperacusis<ref>{{Cite journal |last1=Aazh |first1=Hashir |last2=Landgrebe |first2=Michael |last3= Danesh |first3=Ali A. |last4=Moore |first4=Brian Cj |date=2019 |title=Cognitive Behavioral Therapy For Alleviating The Distress Caused By Tinnitus, Hyperacusis And Misophonia: Current Perspectives |journal=Psychology Research and Behavior Management |volume=12 |pages=991–1002 |doi=10.2147/PRBM.S179138 |issn=1179-1578 |pmc=6817772 |pmid=31749641 |doi-access=free }}</ref> and the usefulness of CBT for noxacusis is not yet demonstrated in the scientific literature.

=== Surgery ===
Studies have shown improved loudness discomfort levels in patients with hyperacusis after round and oval window reinforcement.<ref name=pmid29312994/>

A case of chronic ear pain associated with hyperacusis after exposure to loud noise at a concert was successfully treated with tympanic neurectomy.<ref>{{Cite journal |last1=Ally |first1=Munira |last2=Moinie |first2=Ahmad |last3=Lomas |first3=Joan |last4= Borsetto |first4=Daniele |last5=Mochloulis |first5=George |last6=Bance |first6=Manohar |last7=Boscolo-Rizzo |first7=Paolo |last8= Vijendren |first8=Ananth |date=2022-09-26 |title=Aetiology and management options for secondary referred otalgia: a systematic review and meta-analyses |url=http://dx.doi.org/10.1007/s00405-022-07638-7 |journal=European Archives of Oto-Rhino-Laryngology |volume= 280 |issue=1 |pages=47–59 |doi=10.1007/s00405-022-07638-7 |pmid=36163556 |s2cid=252541522 |issn=0937-4477 |hdl= 11368/3030424 |hdl-access=free }}</ref>

=== Anecdotal medication data ===
The tricyclic anti-depressant [[clomipramine]] (brand name Anafranil) has been anecdotally useful for many people with hyperacusis. Both loudness hyperacusis and noxacusis have been successfully treated with this drug.  A dosage of up to 200–250&nbsp;mg daily for a sustained period of six to twelve months may be needed to cure hyperacusis.  A possible mechanism of action of this drug is that clomipramine reduces reactions of the autonomic nervous system to sounds.<ref>{{Cite journal |last1=Zahn |first1=Theodore P. |last2= Insel |first2=Thomas R. |last3=Murphy |first3=Dennis L. |date=July 1984 |title=Psychophysiological Changes during Pharmacological Treatment of Patients with Obsessive Compulsive Disorder |url=https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/psychophysiological-changes-during-pharmacological-treatment-of-patients-with-obsessive-compulsive-disorder/BA3CB3E6FFF279A02941FC4C7B38AAF8 |journal=The British Journal of Psychiatry |language=en |volume= 145 |issue=1 |pages=39–44 |doi=10.1192/bjp.145.1.39 |pmid=6378303 |issn=0007-1250|url-access=subscription }}</ref>

The drug [[ambroxol]] helps relieve the pain experienced by several pain hyperacusis patients.

=== Treatment for suicidal thoughts ===
Suicidal ideations are a risk factor in hyperacusis patients. Hashir et al. (2019) interviewed 292 patients and found that 15.75% had expressed suicidal ideations in the previous two weeks of the study. They recommend screening for these issues.<ref>{{Cite journal |last1=Aazh |first1=Hashir |last2=Landgrebe |first2=Michael |last3=Danesh |first3=Ali |date=2019 |title=Parental Mental Illness in Childhood as a Risk Factor for Suicidal and Self-Harm Ideations in Adults Seeking Help for Tinnitus and/or Hyperacusis |url= https://pubs.asha.org/doi/full/10.1044/2019_AJA-18-0059 |journal=American Journal of Audiology |volume=28 |issue=3 |pages= 527–33 |doi=10.1044/2019_AJA-18-0059 |pmid=31184510 |s2cid=184486189 |via=ASHAWIRE|url-access=subscription }}</ref>