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Aspergers and Noise Sensitivities [Hyperacusis]

Question

My son has Asperger's syndrome and is sensitive and has a meltdown if I talk or anyone else talks to loudly, because he said he doesn't like loud voices or yelling. He is 22 and can't hold down a job. His social worker raises her voice often when talking to him. He said he requested for her to talk more calmly to him because the conversations repeat in his head for hours if she talks to loud or says something in a tone that could be taken the wrong way if interpreted literally. She refused. Is that wrong? Should someone respect his wishes and talk more calmly if they know he has Asperger's and it causes him so much anxiety and hours of conversation analysis and repeating and he told them so, especially to someone like a social worker? Thanks.

Answer

You may want to consider educating your son's social worker about hyperacusis, which is a disorder characterized by oversensitivity to certain frequency ranges of sound. An individual with severe hyperacusis has trouble tolerating everyday sounds, most of which might seem unpleasantly noisy to that particular individual but not to other people. The disorder is often chronic and usually accompanied by tinnitus (i.e., ringing in the ears), but can occur in people who have little or no measurable hearing loss.

Hyperacusis can come on suddenly or gradually. It can initially affect only one ear, but generally, within a short time, the condition is almost always bilateral. It can be mild or severe. Hyperacusis is more common in children with:

• attention deficit disorder (ADD)
• autism and autistic-like behaviors
• central auditory processing disorder
• head injury
• learning disabilities

It may be developed due to injury sustained to the inner ear. There is conjecture that the efferent part (i.e., fibers that originate in the brain which serve to regulate sounds) associated with the auditory nerve (i.e., olivocochlear bundle) has been impacted. This particular theory shows that the efferent fibers from the auditory nerve are uniquely damaged, while the hair cells that permit the hearing of pure tones in an audiometric evaluation stay intact.

In cases not involving aural injury to the inner ear, hyperacusis may also be developed due to injury to the brain or the neurological system. In these instances, hyperacusis can be explained as a cerebral processing problem specific to how the brain interprets sound. In extraordinary instances, hyperacusis might be the result of a vestibular disorder. This kind of hyperacusis, called vestibular hyperacusis, is brought on by the brain perceiving particular sounds as motion input in addition to auditory input. 40% of tinnitus sufferers complain of mild hyperacusis.

A crying baby, a car with screechy brakes, turning newspaper pages, running water in the kitchen sink, a child placing dishes and silverware on the table – all are intolerable to the ears of someone with hyperacusis.

Causes-

The most typical reason for hyperacusis is over-exposure to exorbitant decibel levels (or sound pressure levels). Many people get hyperacusis abruptly by way of:

• firing a gun
• having an airbag deploy in their car
• experiencing any extremely loud sound
• head injury
• Lyme disease
• Ménière's disease
• surgery
• taking ear sensitizing drugs
• TMD (Temporomandibular joint disorder)

Others are born with sound sensitivity (Superior Canal Dehiscence Syndrome), or have experienced a history of ear infections, or come from a family that has had hearing difficulties.

Causes include, but are not restricted to:

• A vestibular disorder
• Adverse drug reaction
• Asperger syndrome
• Autism
• Bell's palsy
• Chronic ear infections
• Ear irrigation
• Facial nerve dysfunction
• MAO inhibitor discontinuation syndrome
• Ménière's disease
• Migraine
• Minor head injury
• Severe head trauma
• Superior canal dehiscence syndrome (SCDS)
• Surgery
• Tay-Sachs Disease
• Temporomandibular joint disorder (TMJ)
• Tension Myositis Syndrome
• Williams Syndrome

Symptoms-

In cochlear hyperacusis (the most common form of hyperacusis), the symptoms are ear discomfort, irritation, and general intolerance to any sounds that most individuals don't notice or consider uncomfortable. Crying spells or anxiety attacks might derive from cochlear hyperacusis. Up to 86% of hyperacusis sufferers also have tinnitus.

In vestibular hyperacusis, the sufferer may experience feelings of lightheadedness, nausea or vomiting, or perhaps a lack of balance when sounds of certain pitches are present (e.g., they may feel like they are falling, and as a result, involuntarily grimace and clutch for something to brace themselves with). The degree to which a sufferer is impacted is dependent not only on the overall severity of the person's signs and symptoms, but additionally on whether the individual can identify sounds in that frequency range at the volume in question, and also on the individual's pre-existing muscle tone and severity of startle response.

Anxiety, stress, and/or phonophobia might be present in both kinds of hyperacusis. Somebody with either type of hyperacusis might adopt avoidant behavior in order to stay away from any nerve-racking sound situations or to prevent embarrassing themselves in a social situation that may include painful sounds.

An individual struggling with hyperacusis may be shocked by really low sound levels. Daily sounds may hurt his/her ears, for example:

• chewing gum
• cooking
• dishes
• eating
• normal conversation
• ringing phones
• running water
• shutting doors
• television
• ticking clocks

The person who has hyperacusis can't simply get up and walk away from noise. Instead, the volume on the whole world seems stuck on high. In the worst case scenario, even the use of earplugs does not provide comfort, and the individual might spend his life attempting to avoid all noises and merely stay home.

Treatment-

Steroids are used to treat hyperacusis within 72 hours of the onset of the condition.

The most typical treatment for hyperacusis is retraining therapy, which uses broadband noise. Tinnitus Retraining Therapy (TRT), a treatment originally used to treat tinnitus, uses broadband noise to treat hyperacusis.

Pink noise may also be used to treat hyperacusis. By listening to broadband noise at soft levels for a disciplined period of time each day, patients can rebuild their tolerances to sound.

When looking for treatment, it is important that the doctor determine the patient's Loudness Discomfort Levels (LDL) so that hearing tests (brainstem auditory evoke response) or other diagnostic tests which involve loud noise (MRI) do not worsen the patient's tolerance to sound.

Hyperacusis makes living in this noisy world difficult and dramatically changes a person's life-style. Moving about, traveling, and communicating with others is challenging. Ear protection must be worn in areas that seem too loud. This includes earplugs, industrial earmuffs, or both if necessary.

Individuals who suspect they may have hyperacusis should seek an evaluation by an otolaryngologist (i.e., an ear, nose, and throat doctor). The initial consultation is likely to include a full audiologic evaluation (with a hearing test), a recording of medical history, and a medical evaluation by a physician. Counseling about evaluation findings and treatment options may also be provided at that time.

The Aspergers Comprehensive Handbook

9 comments:

Anonymous said...

I'm the original asker of this question. What about being sensitive though to the tone of voice of people and then having the conversations looping or repeating in my son's head? He said they loop through his head for hours and he has to keep going over that portion of the conversation where the tone was too loud. I've read on another site about the this and the looping effect of Asperger's Syndrome. The social worker, when asked to talk more calmly, refused. He said he told her about his Asperger's Syndrome and how if her tone is too high it repeats in his head and he can't stop it. Once again she won't comply. Is it time to explain things better to her or find another social worker? Thanks again for everything! :)

Anonymous said...

He's describing the loud tone as a feeling of guilt. He says it doesn't hurt. It just gives him a melting feeling on the inside and he's sensitive to the tone and thinks they may be mad, when maybe they're not in reality. Taking the tone of voice literally, then having the looping effect in his brain. He doesn't have problems with other loud sounds, expect for lawnmowers. He has to wear earplugs, which I guess is a good thing. He does suffer from ringing of the ears and has for years.

Jennifer said...

Please get another social worker ASAP, she is obviously not sensitive enough to his limitations and his needs. I do not have aspergers but if someone is speaking too loudly to me I am sensitive to the noise aspects as well and I couldn't tolerate a raised voice in a meeting where someone was supposed to be helping me. My son has aspergers and he has the same sensitivity to noise, especially in relation to sensitive topics or an argument. People working with the public are expected to be adaptable, so if they are not working with your son effectively, replace them. He's the one who is the "client" in this situation.

Anonymous said...

what can be done to help with sensitivity to loud unexpected sounds? I can only prepare for the noises I know will happen. Our son is 7 1//2 yrs old and is HFA with a moderate hearing loss. He experiences so much anxiety with this problem. LUckily is does not happen much but when it does it is very tough for him to work through. ANd have you ever heard of cochlear hypercusis? THX

Anonymous said...

Jessica Swift We've been dealing with this for years. My eldest is 7 and has this problem, and my middle child is 5 and has this problem as well. We try to make noise blocking headphones available, but beyond that we haven't found a solution. We tried some sort of listening therapy with CD's provided by their OT, but it didn't help for us.

Anonymous said...

My 8 year old ASP/ADHD son is also bothered by noises. Especially loud ones like vacuum, blender, etc. We have several pairs of noise blocking headphones. We do have ear plugs (disposable types) but he tends to chew on them, which makes them useless. At school they discourage anything around his neck for strangling hazards. Inquire with his teacher if there are any guidelines for that.
It is frustrating as a parent to be unable to control that part of the environment so that his learning is optimal.

Anonymous said...

My daughter is the same way. I tried to send ear plugs they were in a case and she could just put them in however she prefers ones with cords because in health class they told them not to pu things in their ears as they could get stuck so she likes the cord so she can pull them out. I did nit want the cord so they would not be as noticeable but I understand why. There are lots of different kinds just try some and find what works best! Good luck!

Anonymous said...

my son is the same .. hes 7 .. doesnt like it when others sing .. but he loves up to date music! and knows all the words but doesnt like music when its noisy or loud .. but strangely he likes his mp3 player!

Anonymous said...

Yes, my son doesn't like anybody singing either. He says it bothers his ears. He likes soft music like lullibyes or soft 70s/80s music. He used to really get very upset & put his hands over his ears & say stop the music very loudly. Now he's now putting his hands over his ears most of the time with me telling him lets not yell . We homeschool so luckily I don't have the issues with teachers. My husband & I haven't tried to take him to church in quite a long while because of his strong reaction to music. I do have to say I haven't had him diagnosed with AS but plan on talking to his dr. very soon. He was born with heart condition so that was a priority for awhile. At 3 is when I noticed he didn't like loud music.I thought that it was because we were inside all the time that he didn't like the noise but that's not the case though. I don't feel so alone now.

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