Noise Sensitivity and Multiple Sclerosis

Hyperacusis can result from damage to parts of the brain from MS

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If you have multiple sclerosis (MS) and experience discomfort in response to certain sound volumes or frequencies, you might not have realized that these symptoms may be caused by your disease. This condition, called hyperacusis, can be among the subtle effects of MS. This sound sensitivity can interfere with your ability to concentrate, socialize, or even sleep.

Symptoms related to hyperacusis may wax and wane. There are a few treatments for the condition, but lifestyle coping mechanisms are generally the key when it comes to managing hyperacusis.

Hyperacusis
Verywell / Gary Ferster 

Symptoms

Hyperacusis is characterized by an increased sensitivity to everyday sounds. Most of the time, this hypersensitivity is accompanied by an aversion to the sounds, even if they are not typically considered unpleasant. In fact, you may be surprised that you are so easily bothered by noise. You may also feel head or ear pain, generalized physical discomfort, and annoyance in response to noises, even if they are soft or high pitched.

Hyperacusis can affect one or both ears and you may have a heightened ability to hear certain noises even as you lose the ability to hear other sounds or frequencies. 

You may also experience tinnitus (ringing in the ears), dizziness, loss of balance, nausea, or vertigo along with your hypersensitivity to sounds. This is because the region in the brain that controls hearing also controls your sense of balance.

The impact of hyperacusis is not just physical. If you experience pain, annoyance, or discomfort as a result of hyperacusis, you may start to isolate yourself. This can lead to depression or anxiety.

Causes

Hyperacusis can occur when an injury or disease affects the brainstem or the vestibulocochlear nerve (also called the eighth cranial nerve). All of these structures work together to control hearing and balance. In MS, hyperacusis can occur when the disease affects the brain stem

Multiple sclerosis is a demyelinating disease in which the protective myelin coating on nerve cells in the brain, spinal cord, and optic nerve (which detects visual input) are diminished. This causes the nerves to function abnormally.

While any number of other conditions can cause hyperacusis (ranging from ear infections to neurotoxins), it is most often seen after the age of 50. This is because the dysfunction of these regions is common with aging. And the additive effects of MS demyelination can exacerbate the effects of auditory dysfunction, making the symptoms more noticeable than they would have been otherwise.

Diagnosis

If your heightened sense of hearing is impacting your quality of life, ask your doctor for a referral to a qualified audiologist, who will be able to conduct a complete hearing evaluation and discuss treatment options with you.

An objective diagnostic test that measures uncomfortable loudness levels (ULL) can define your degree of hyperacusis. This can also help distinguish the diagnosis from several other similar conditions.

Differential Diagnoses

There are some overlaps between hyperacusis and phonophobia, which is an aversion to certain sounds. If you have phonophobia, you are likely to experience discomfort in response to sounds, and the noises may trigger headaches, migraines, or a sense of pain. In extreme situations, phonophobia can actually manifest with a true fear of certain sounds, due to their anticipated effects.

Another similar condition, misophonia, is characterized by extreme irritation, annoyance, and agitation in response to noises. If you have misophonia, you may be angered by sounds such as chewing, typing, or other quiet, repetitive noises.

That said, symptoms of phonophobia and misophonia can accompany hyperacusis. Hyperacusis is typically associated with hearing loss, while phonophobia and misophonia can also occur without hearing loss or hyperacusis.

Treatment

Often, the most effective treatment for MS-associated hyperacusis is treatment of the MS exacerbation that is amplifying the symptoms. However, if your symptoms persist after an MS exacerbation has resolved, or if you have a progressive form of MS with major residual symptoms, then you may want a treatment that is specifically directed at reducing your hyperacusis.

Treatments for hyperacusis include:

  • Auditory retraining therapy: You can talk with your occupational therapist about specialized therapy. Auditory retraining employs techniques by which you can work with your therapist to train your body to experience less pain or discomfort in response to certain noises.
  • Counseling: You can work with a psychologist or counselor to learn how to cultivate mindfulness to reduce your reactions to hyperacusis and even to think about sound in a more positive way.
  • Surgery: In rare instances, such as when you also have persistent ringing in the ears, or when the hypersensitivity is interfering with your life, you may be a candidate for surgery. A procedure involving reinforcement of some of the bony and soft tissue structures that mediate hearing may improve your symptoms.

Coping

You may decide that it is better to use lifestyle adjustments to cope with your condition rather than getting medical treatment. There are some practical strategies you can use, especially if you only have symptoms at certain times or in response to certain noises.

Use Earplugs

You can use noise blocking headphones or earplugs if you have hyperacusis during situations such as riding on an airplane or a bus, or if you are trying to work in a noisy place. While it can't alter the actual functioning of your nerves or brainstem, constantly blocking sound may recalibrate your awareness of sounds.

Once the earplugs are removed, the over-amplification of sound may actually cause further distress, so it's best to only wear the earplugs when you need them.

Clear Noise Clutter

Start by segregating sounds in your environment. Getting rid of excess noises like the TV, a ticking clock, a spinning hard drive, or a bathroom fan so you won't have these distracting sounds in the background all the time.

Shift Your Listening Focus

Practice focusing on one sound at a time, prioritizing just what you need to hear. When you are talking to someone, try to tune into only their voice and not the other things around you. As you begin to do so in your own environment, you can slowly apply the same technique in other situations.

Identify Triggers

Try to figure out which sounds bother you the most. The more you become aware of these, the more you can anticipate them and avoid an emotional response. 

Get Support From Others

Tell the people who you are close to that you are especially sensitive to noise. In most cases, people will respond positively and lower the excessive noise in the room.

A Word From Verywell

While there are no easy answers for hyperacusis, there are options. It may sound like a minor complaint to you, but if this problem is impacting your quality of life, it deserves the same attention as other MS symptoms, such as vision loss and trouble walking.

Try to identify whether you are experiencing hyperacusis, misophonia, phonophobia, or a combination of these so that you and your doctor or therapist can work toward the best solution to fit your needs.

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