Other

ASD Management Guidelines
Electronic Hearing Devices
Future Therapy: Multimodal Neurostimulation
Alternative Treatments

ASD Management Guidelines

Acoustic Shock Disorder (ASD) is a term sometimes used to define the combination of hyperacusis and Tonic Tensor Tympani Syndrome (TTTS) when they triggered by an acoustic incident. The audiologist Myriam Westcott has provided ASD management guidelines on her website. As discussed in Potential Mechanisms: Middle Ear, the assumption with these guidelines is the pain in hyperacusis patients is triggered from a hyperactive tensor tympani muscle and irritation of the trigeminal nerve. Keep in mind this mechanism (like all hyperacusis mechanisms) is hypothetical and has not been proven.

  • If pain levels are severe, they recommend treatment for trigeminal neuralgia and/or referral to a pain management clinic.
  • Cognitive behavioral therapy to manage auditory hypervigilance, stress and sleep management.
  • Hyperacusis desensitization therapy.
  • Massage of nerve and muscular trigger points around the neck and shoulder. This is a common technique for TMD therapy.
  • Avoid exposure to unexpected loud sounds until fully recovered (for example from work involving call center headsets).

Electronic Hearing Devices

As described in Earplug Use: Overprotection, there have been studies that use electronic hearing devices to treat severe hyperacusis patients. These are essentially hearing aids without amplification and with sound compression features enabled. Ideally, these devices should decrease anxiety as the patient would no longer need to anticipate and protect for the worst case scenario of sound exposure. Below is a summary of the potential benefits of this treatment:

  • Increased average sound exposure as patient does not need to protect for worst case scenario.
  • Reduction in anxiety as patient is not required to anticipate loud sounds.
  • Ability to slowly increase the gain of softer sounds for controlled increase of average sound exposure.
  • Ability to slowly increase the compression limit of louder sounds for controlled increase of peak sound exposure.
  • Potential to introduce different sound therapies in the background at controlled levels.
  • Potential for research into setbacks and recovery. If the hearing devices are modified to monitor sound dosage they could be used to assess the impact of sound exposure on setbacks. This monitoring could also be used to track recovery progress as the patient would adjust the device according to their discomfort over time.

Practical issues such as hiss from electronic noise, sound while speaking or eating, and uncomfortable amplification of softer sounds would need to be managed.

Future Therapy: Multimodal Neurostimulation

A new therapy is being developed to more precisely reduce activity within the auditory system by synchronously sending touch and sound signals. Results show that this method is more effective than sound alone in reducing activity at higher levels of the auditory system (auditory cortex and inferior colliculus). It is possible that this method could be used to target lower levels as well (cochlear nucleus).

Alternative Treatments

There are some treatments thought to improve most disorders in general. Alternative treatments are often given special attention for chronic pain, which shares similarities to pain hyperacusis. Below are some common alternative treatments:

  • Supplements and Vitamins
    • Magnesium has been shown to reduce hearing loss
    • Antioxidants have been shown to limit damage in the inner ear in some cases.
    • Neither have been studied in relation to hyperacusis.
  • Warm or cold compress on outer ear to alleviate pain
  • Acupuncture
  • Exercise
  • Stress and Anxiety Reduction Techniques
    • Yoga
    • Meditation
    • Relaxation Therapy
    • Hypnosis
    • Massage

Next: Earplug Use

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References

Cevette M, Vormann J, Franz K. Magnesium and Hearing. Journal of the American Academy of Audiology 2003:14(4):202-212.

Markovitz C, Smith B, Gloeckner C, Lim H. Investigating a new neuromodulation treatment for brain disorders using synchronized activation of multimodal pathways. Scientific Reports 2015:5:1-12.

Sammeth C, Preves D, Brandy W. Hyperacusis: Case studies and evaluation of electronic loudness suppression devices as a treatment approach. Scand Audiol 2000:29:28-36.

Valente M, Goebel J, Duddy D, Sinks B, Peterin J. Evolution and treatment of severe hyperacusis. J Am Acad Audiol 2000:11:295-299.

Westcott M. Acoustic Shock and TTTS Guide for Medical Professionals. http://www.dineenwestcottmoore.com.au/specialist-services/acoustic-shock#what-is-as