There have been no clinical trials for medication applied to hyperacusis. As a result, guidelines for prescribing medication to hyperacusis patients vary among doctors and rely on clinical experience and educated guesses. As medication has not been thoroughly researched for hyperacusis and has potential for negative side effects, those with hyperacusis should carefully discuss the pros and cons of medicinal treatment with their doctor.
Dr. Timothy Hain from Chicago Dizziness and Hearing created a flow chart for a systematic way of managing hyperacusis on the hyperacusis page of their website that includes medicinal options:
Without clinical trials, this chart likely reflects Dr. Hain’s clinical experience in treating hyperacusis with a total of 33 hyperacusis patients in the clinic’s patient database. Dr Hain finds medication may not efficiently address the root cause of hyperacusis but can be useful in alleviating psychological issues that can develop:
“In general, we are not at all enthused about medication treatment as the side effects can be substantial and the results are often unimpressive. Medications to deal with the psychological fallout of hyperacusis is often useful — antidepressants and anti-anxiety medications can be very helpful.”
-Dr. Hain from Chicago Dizziness and Hearing website.
Although hyperacusis is uncommon, most doctors should be familiar with the potential risks of the listed medications.
In the hyperacusis literature review by Tyler et al., medication applied to hyperacusis was reviewed as follows:
“The published work is limited to clinical case reports. Johnson, Brummett, and Schleuning (1993) described the use of Alprazolam [Xanax] (a short-acting anxiolytic) in five patients presenting with tinnitus and hyperacusis. A complete remission of hyperacusis was observed after 8 weeks of treatment. Nields, Fallon, and Jastreboff (1999) described the use of Carbamazepine (an anticonvulsant and mood-stabilizing drug) for the relief of hyperacusis in two patients diagnosed with Lyme disease. Gopal, Daly, Daniloff, and Pennartz (2000) described the use of selective serotonin receptor inhibitors (Fuvloxamine and Fluoxetine) for one patient with complete remission of hyperacusis and increase of ULLs. Some anecdotal success has also been reported for Citalopran (another selective serotonin receptor inhibitor). Controlled studies are needed.”
A Review of Hyperacusis and Future Directions: Part II. Measurement, Mechanisms, and Treatment by Pienkowski, Tyler et al.
Conclusions cannot be drawn from the limited evidence available.
As hyperacusis is very rare, it is likely that a drug that reduces hyperacusis symptoms will have been developed for something else. There is currently activity in drug development for hearing loss and tinnitus that may directly or indirectly improve medicinal treatment options for hyperacusis in the future. Tinnitus occurs in 84% of hyperacusis patients and hyperacusis occurs in 30-60% of tinnitus patients which suggests that the two disorders are related in some way. Medication for tinnitus could relieve the tinnitus symptoms present in the majority of hyperacusis patients. It may also alleviate hyperacusis symptoms if the mechanism of action is shared by both disorders.
For hearing loss, Frequency Therapeutics has developed a drug that is undergoing clinical trials (FX-322). It has been shown to restore hearing loss in mice and improve processing of sound in the presence of noise in humans. For tinnitus, neuromodulation devices such as Lenire may also help with hyperacusis. Medication being developed by Thanos Tzounopoulos’ group at the University of Pittsburgh is attempting to refine the powerful anticonvulsant known as Retigabine into a medication with fewer side effects. The mechanism of action of this medication is expected to reduce tinnitus.
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Pienkowski M, Tyler R et. al. A Review of Hyperacusis and Future Directions: Part II. Measurement, Mechanisms, and Treatment. American Journal of Audiology 2014:23:420-436.