Noise and Stress

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Hyperacusis

• Hyperacusis is an abnormal sensitivity to sound.
  About 8 of the population report hyperacusis
• Andersson, G., N. Lindvall, et al., 2002.

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What causes hyperacusis ?

• Inner ear -- e.g. Menieres's disease
• 8th nerve -- e.g. microvascular compression
• Brainstem
• Brain migraine
• Psychological

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Brain causes

• Hyperacusis is very often associated with
  Migraine (where it is caused phonophobia).
• Because migraine is extremely common (10 of the
  population), it likely accounts for at least 90
  of all hyperacusis.

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prolonged exposure to noise actually results in

• sleep disturbances
• increased blood pressure
• decreased learning ability
• elevated stress hormones
• loss of productivity
• increased heartbeat
• digestive cramps
• breaking out in a cold sweat
• uncontrollable trembling or shivering

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• Neurotologic symptoms are common with migraine.
• Motion sensitivity with bouts of motion sickness
  occurs in about two thirds of patients with
  migraine.
• Episodes of vertigo occur in about one fourth of
  patients and, in some, vertigo is the only
  symptom.
• Phonophobia most common auditory symptom, but
  fluctuating hearing loss and acute permanent
  hearing loss occur in a small Percentage.
• Migraine can mimic Meniere's disease and
  so-called "vestibular Meniere's disease" is
  usually associated with migraine.
• A defective calcium channel, primarily expressed
  in the brain and inner ear, could lead to
  reversible hair cell depolarization and auditory
  and vestibular symptoms.

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Mechanism of phonophobia in migraine

• Migraine involves serotonin pathways, which are
  also postulated to be at the root of central
  hyperacusis .
• In theory, hyperacusis might also be due to an
  irritibility of central auditory pathways, as for
  example, in a person with a seizure disorder.
• Reflex Epilepsy

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• The findings do not support the view that
  phonophobia in migraine is a manifestation of
  loudness recruitment, although cochlear
  disturbances might mediate hearing loss in some
  cases.
• Disruption of central sensory processing
  mechanisms during migraine could increase
  sensitivity to quiet sounds, and contribute to
  phono- and photophobia.

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• Chronic intermittent noise exposure causes
  alterations of pituitary-adrenocortical and
  sympathetic neural system responses.
• A single short-term noise exposure at a sound
  pressure level of 90 dB, however, had no effects
  on the endocrine stress systems.
• The response of the animals rather depended on
  the quantity of the accumulated noise. The more
  frequent noise stimulation resulted in an earlier
  sympathoneural activation.
• Pituitary-adrenocortical responses to noise
  showed sensitization followed by desensitization
  in daily stressed pigs. The results also indicate
  that repeated noise stress causes growth
  retardation and may lead to behavioural
  suppression in pigs.

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Hyperacusis in cluster headache

• During bout, CH patients were more sensitive to
  light and sound than controls (p lt 0.001).
  Outside bout they did not differ significantly
  from controls.
• Patients were more photophobic and phonophobic
  during bout than in the remission period.
  However, for those tested during bout, the
  sensitivity to light and sound was not related to
  the presence of pain during test, usual pain
  intensity, or pain laterality.
• In response to a questionnaire about their
  sensitivity, a significantly higher proportion of
  patients considered themselves sensitive during
  bout than outside .
• These results indicate that photophobia and
  phonophobia are important accompanying phenomena
  of cluster bouts.
• Vingen JV, Cephalalgia. 1998 Jun18(5)241.

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Hyperacusis in cervicogenic and tention headache

• patients with cervicogenic headache and patients
  with tension-type headache are significantly more
  sensitive to light and sound than controls, even
  when are tested in the headache-free period.
• Episodic and chronic tension-type headache had
  similar photo- and phonophobia thresholds .
  Tension-type headache patients were more photo-
  and phonophobic during headache than outside
  attack.