CHAPTER SEVEN
Tinnitus and Hyperacusis
David M. Baguley, Ph.D.

It is relatively well established in the public mind that being in the midst of intense sound may lead to tinnitus (ringing), and many high profile musicians are susceptible. One example mentioned in an earlier chapter is The Who’s guitarist and songwriter Pete Townshend, who overused headphones at massive intensity while recording in the 1970s and has noise-induced hearing loss and tinnitus as a consequence. Hyperacusis (hypersensitivity of hearing) is given less attention, but can be a debilitating symptom associated with noise exposure.

In this chapter, tinnitus and hyperacusis are defined, and the mechanisms that can cause them to be troublesome as a consequence of noise exposure are discussed. The problems associated with these symptoms, such as anxiety, sleep disturbance and irritability are reviewed, and then hopes for recovery and how this might be achieved through therapy are considered. Finally, prospects for future research are proposed.

Tinnitus has been known since ancient times, with references in the early medical texts found on clay tablets in Ancient Babylon, and in medical writings from Ancient Greece and Rome. The word “tinnitus” itself derives from the Latin verb tinnire (to ring) though ringing is only one of many manifestations of the symptom. It’s worth repeating from Chapter 1 that it is pronounced TINN’-ih-tuhs or tih-NEYE’-tuhs. A widely used modern definition of tinnitus is, “The conscious expression of a sound that originates in an involuntary manner in the head of its owner, or may appear to him to do so” though even this is not perfect as many people may experience tinnitus that appears to originate outside the head or even elsewhere in the body.

The experience of tinnitus is common. About a third of adults in western countries say they have experienced short-lived spontaneous tinnitus from time to time, and about one in ten says that tinnitus is troublesome for them. About one in twenty adults has sought a medical opinion, and in one in 200 people, tinnitus is severe and has a significant negative impact upon life. Interestingly, if children are asked carefully and in appropriate language about tinnitus, the figures are similar to those in adults. This equates to over 1.5 million Americans having tinnitus that impact upon their quality of life. Having hyperacusis does not mean that you have supersensitive hearing like Superman. Rather, it describes a symptom where sound that is not especially loud, and not bothersome to other people, seems overwhelming and intense. A scientific definition is, “abnormal lowered tolerance to sound.” The word hyperacusis entered the medical literature in 1938, but the symptom was not given wide attention until the last decade. Some researchers have made the distinction between hyperacusis and other sound tolerance problems associated with fear (phonophobia) or aversion to sound (misophonia). A well established self-help resource for hyperacusis called the Hyperacusis Network (www.hyperacusis.net) likes to use the phrase, “collapsed sound tolerance” which carries some emotional impact.

It is not a simple matter to determine how many people have hyperacusis. A Swedish study proposed a figure of 8%, but many experts think this is an overestimate, and the real figure is about 2%. Tinnitus and hyperacusis often occur together: nearly half the people who complain of tinnitus have hyperacusis, and over 80% of people who complain about hyperacusis have tinnitus.