Dealing with Hyperacusis after Concussion
Recovering from a terrible symptom that becomes a hidden disability
What is hyperacusis?
After a concussion, a common symptom people experience is a heightened sensitivity to sound and noise, especially unexpected loud noises. Even the sound of your own voice might become irritating to you. There’s a fancy word for this condition. Hyperacusis.
But it’s a mistake to think of hyperacusis as merely an increased sensitivity to sound. It’s connected to a larger sound-processing issue.
One of the more debilitating problems is the loss of one’s ability to focus on a particular sound while excluding other sounds—to listen to one person speak while tuning out other conversations and noises happening around you in, say, a restaurant.
When your brain gets overwhelmed by sound, the experience feels something akin to being in a room made entirely of televisions without the ability to focus your eyes on a given screen. The sensory overload is overwhelming.
Where I’m at today
For those of you suffering from hyperacusis, what I’m about to describe might sound somewhat miraculous. For everyone else, I hope the following helps you to understand what other people go through and to appreciate the things you take for granted.
Yesterday, I went to a cafe. Inside the relatively small space were about 20 people, almost all of them talking. Heavy metal was playing from various speakers.
There were about eight people in line at any given time. As I moved to the middle of the line, there were roughly four people talking behind me, and about the same number conversing in front of me. I myself was in a party of four having our own conversation.
As we placed our order and I dealt with the touch-screen payment device, someone knocked a wooden sign over on the counter and it made a hammering smack as loud as a small firearm, about two feet from my right ear.
I had an entirely appropriate startle response. My head and neck moved very quickly toward the noise, about three or four inches, and I saw the source of the loud sound.
I did not have an adrenaline spike. I did not feel completely overwhelmed by the “last straw” of a startling sonic stressor. I simply turned to finish my payment, took my number, and walked to a table, where I sat for about an hour talking with friends. There was a door right behind my chair, through which people entered and exited at random.
Only now, as I describe this scenario, do I fully recognize what a terrible minefield this situation would have been for me in the past. It would’ve been yet another social situation where I was doing my best to keep it together and hide my bordeline overwhelm from my companions.
Believe it or not, none of that ever occurred to me. It was a non-event, an experience I took for granted, just like my companions did.
The only moment I consciously registered as notable was my startle response to the sudden loud noise, in part because unpredictable loud noises plagued me for years.
What hyperacusis does to you over time
Hyperacusis and sound-processing issues are one of the worst things one can deal with, in part because these symptoms make you shrink your life into a smaller and smaller box where you can control the sound levels if nothing else.
Fear and avoidance become self-perpetuating. One crosses a threshold between symptoms caused by injury, and symptoms caused by maladaptive responses in one’s nervous system.
The mind is a powerful thing. There are people in this world who experience any touch from another person as pain. They arrive at that state because they had a legit injury or experience that began a cycle. A similar thing can happen with your relationship to sound and noise after a concussion.
These symptoms can easily become a hidden disability. I wrote a piece about hidden disability that many people have found useful, and my experience with hyperacusis was a major factor in that experience.
The whole truth about treating hyperacusis after a concussion
In the aftermath of a concussion, if we suffer from hyperacusis, we might go to various doctors seeking treatments. Maybe we start with a hearing specialist or an ENT or a neurologist, and those appointments are often dead-ends, apart from ruling out certain conditions.
As many of you know well, people who continue to suffer after a concussion are often told that their symptoms are all in their heads. We might be told that the way forward involves some level of re-habituation to sound, noise, etc. And this might come across as more of the same “It’s all in your head” nonsense.
The whole truth? We had a real injury that may have lingered in the form of inflammation sites in our brains, but since our symptoms (including hyperacusis) went untreated for such a long time, we inevitably crossed a threshold, and now some measure of our problem is “psychological.”
The word psychological isn’t as accurate as it could be in this context. It’s more accurate to say that our nervous systems, in an effort to protect us, made maladaptive adjustments that we need to correct through conscious action and retraining.
To fully unwind hyperacusis, we may need to address the root cause of injury as best we can (including the contributing factors listed here) while making behavioral changes that lead to adaptive neuroplastic change.
How does one approach treating hyperacusis?
As someone who suffered from this for a long time, I believe it’s best to approach it on multiple fronts, especially if it’s a feature of post-concussion syndrome.
The following are complications and/or contributing factors. One or more of these factors are likely working in concert. None should be glossed over or assumed to be a non-issue. I include a few treatment options for each one.
Contributing factors or complications:
Whiplash and damage to the neck, especially to the muscles and nerves around the ear. Nerve pathways that flow through the neck (including the vagus nerve) also play a key role in the modulation of the nervous system between “fight or flight” and “rest and digest.”
Related to whiplash and neck injury, nerve inflammation and irritation, particularly in the area where the spine meets the skull, can make the vibrations of your own voice irritating, and perhaps lead to heightened sensitivity to all sounds.
Treatment options for this include acupuncture, dry needling, cupping, atlas orthogonal chiropractic, physical therapy that includes neck joint manual manipulation, vestibular rehab that includes the neck, pulsed electromagnetic frequency therapy (such as the NeoRhythm), pulsed laser light therapy (such as a Bioflex laser), hot and cold baths with or without epsom salts, massage, and the general reduction of inflammation. If you’re going to take an over-the-counter anti-inflammatory medication for a short period of time, the generally accepted recommendation is Tylenol, but check with your relevant medical professional before adding or taking away anything from your regimen.
An atlas bone that’s been knocked to a position that puts chronic strain on the muscles and nerves around the ear (the ends of the atlas come very close to one’s ears).
Treatment options include atlas orthogonal chiropractic, acupuncture, and physical therapy.
A vestibular disorder that, among other things, elevates your levels of stress because your brain is struggling to determine where the body is in space. This difficulty only exacerbates one’s PTSD or hyperactive sympathetic nervous system. There may also be some connection between a brain’s struggle to self-correct bad balance information and its struggle to process sound, but that is conjecture on my part.
Treatment options include vestibular rehab, which may be a long and slow process.
A hyperactive sympathetic nervous system that is perpetually on high alert. This makes one jumpy in general, amplifies one’s senses, and leads to chronic stress. In this mode, one is scanning the environment for threats. Loud noises confirm the presence of a threat.
Treatment options include anything that restores nervous system balance, including daily breathing techniques, meditation, quality sleep, syntonic light therapy, treatments for anxiety and PTSD, etc.
PTSD that might be linked to the unpredictable suddenness of the injury.
Treatment options include CBT therapy, float tank therapy, and re-habituation to related sensations including sudden loud noises.
A principal cause of hyperacusis in post-concussive cases?
One of the structures in the brain that often gets damaged in a concussive injury is the thalamus, which throttles or modulates incoming sensory information. It can amplify sensory information or suppress it.
It turns out that the thalamus isn’t often damaged by impact, but by secondary inflammation in the days and weeks that follow an impact. Damage to the thalamus could be a major factor in sensory overload symptoms.
In animal studies, when damage to this area of the brain was prevented, post-concussion syndrome was dramatically reduced. There’s an article about that here.
Given that most of us don’t know where to begin in healing a damaged thalamus, where does this leave us?
How did I shift my approach to sound, noise, sudden loud shocks?
Since I’ve thrown just about everything at this problem, I am not exactly a controlled experiment. It’s difficult for me to say that one thing or another made all the difference.
Instead, I’ll discuss things I’ve done and how they might have helped with hyperacusis and related problems.
For starters, I had to address all the sources of injury I listed here as contributing factors. I did atlas orthogonal chiropractic, dry needling, physical therapy, vision therapy, and vestibular rehab.
I did a six-month course of syntonic light therapy, which can be helpful with overall sensory processing, not just vision.
I currently use a Vielight device for 20 minutes a day. Might it be addressing lingering inflammation around the thalamus? Maybe. Might it help with sensory processing by targeting the default mode network? Maybe.
Here are two things that definitely helped, and do seem essential.
Mindset shift: Sudden loud noise as a welcome opportunity
If I wanted to rehabilitate myself and my relationship to sound, especially to loud noises that happened unpredictably, I couldn’t do that by myself. That would be like trying to tickle myself. I needed someone to startle me at random.
As it turns out, my wife is a bit of a klutz. Baking sheets dropped in the kitchen when my back is turned? Check. Random things dropped almost daily? Yes. For the longest time, I experienced these events as a neverending torment. Something I could not avoid no matter what I did.
Then I realized that my wife was the perfect training partner.
I began welcoming sudden loud clattering noises as an opportunity—one that I myself could not reproduce. I turned toward these surprising events, emotionally. Could they happen often enough to assist my progression?
When these unpredictable and startling noises happened, I would lock into a feeling—the same feeling I cultivated when I deliberately subjected myself to another external stressor: the cold shower I now take every morning (itself a neurological treatment with many benefits).
Has this shift in mindset to loud noises made a difference? Absolutely. Would this shift in mindset have worked had I not done all the other things? I doubt it. I think those things made this possible. But there’s no question that this is a key step in the progression.
Dealing with the fear of something hitting your head again
I believe that some measure of long-term hyperacusis springs from anxiety—specifically the anxiety one develops in trying to avoid things like loud noises, as well as avoiding things that might hit your head.
When something lightly but unexpectedly touches your head, do you flinch? Is there some (understandable) over-reactivity?
One day, I leaned in the shower and my head touched the wall, and my whole head flinched the way one’s hand reacts to touching a hot stove.
I realized that this fear of anything hitting my head was like a background process in a piece of software, taking up mental and emotional energy.
To ease this, I began bouncing a lightweight ball and letting it come very close to my head each time. Then I let it touch my head at the apex of its bounce. A light touch. I did this several times a day, weaving it into vestibular rehab.
In other words, I began to playfully re-engage in exercises where my fear about ANYTHING touching my head could be leaned into a little, and my fear could steadily subside. Obviously, I still don’t want to get hit in the head, but pushing back on this fear a little was a big relief.
Again, I believe that post-concussion hyperacusis is multi-faceted, so I mention this exercise not because I think it’s going to cure hyperacusis, but because it fits into the constellation of things someone can do to be in a more parasympathetic state when one wants to be, to heal.
After a concussion, hyperacusis can be one of the most challenging and debilitating symptoms. It isn’t just about sound sensitivity, but sound processing and sensory overload. It can easily lead to disability especially when one enters a negative feedback loop.
Injury to the thalamus is a likely contributor, but there are a number of other contributing factors or conditions, many of which have little or nothing to do with the ear itself. It’s important to take a “whole system” approach to recovery.
I’ve outlined many of the steps I’ve taken that were helpful to me in some way, including light therapy, dry needling, and other treatments. Among these is the eventual necessary step of rehabituation to loud noises and sudden stressors, sonic and otherwise.
As always, I hope this information has been beneficial to you and your loved ones. If you know anyone who might benefit from this information, please share and subscribe to Brainwave.
Notable news item:
According to a new study performed at a children’s hospital in Canada, resuming light physical activity (such as a gentle 15-minute walk) 72 hours after a concussion produced better outcomes than postponing such activity. This provides further evidence that the old idea of sitting in a dark room for a week is likely a bad idea and not the best default course of action.
Brainwave is an informational resource for people whose symptoms haven’t resolved after a concussion or mTBI. I endeavor to present this information in a clear and concise way, spelling out what’s backed by science and what remains unknown. Nothing here is meant as a substitute for professional medical advice, diagnosis, or treatment. I am not a physician or a healthcare practitioner of any kind; I’ve simply had a lot of sports-related concussions and had to learn this stuff the hard way. If you found this information helpful or know someone who might benefit from it, please share and subscribe to Brainwave.