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jovial laugh, to Tom Maholchic, feels like a knife stabbing his eardrums. So do all sorts of routine sounds — the sizzle of bacon, the ring of a phone, the rush of running water.

“I feel like I have a year-round sunburn deep inside my ears,” said Maholchic, 27.

Researchers have known for years about a condition called hyperacusis, where ordinary sounds seem uncomfortably loud. But they’re just starting to understand that some patients experience a more severe form, where noise is not just heard — but is actually felt, as physical pain.

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Using new lab tools and techniques, pioneering scientists have identified what appear to be pain fibers in the inner ear, or cochlea. They are coining new terms, including “noxacusis” and “auditory nociception,” for this newly recognized sensation of noise-induced ear pain.

The new diagnosis will be an important topic next week at the annual meeting of the Association for Research in Otolaryngology in San Diego, where a three-hour symposium will introduce the research and explain its implications. While some patients with the condition do improve, others risk a setback every time they hear even a moderate noise.

“People’s lives have been radically altered by the crippling pain that comes with this type of rare noise injury,” said Bryan Pollard, president of Hyperacusis Research, a nonprofit.

“The pain lingers long after the sound is gone, much as the pain from a flesh wound would.”

M. Charles Liberman, Harvard Medical School

Patients’ descriptions of the pain are remarkably similar: A sound is usually perceived as the sharp jab of a knife or skewer. The sensation persists as a searing, burning ear pain, often combined with the pressure known as aural fullness and the ringing known as tinnitus.

Hyperacusis
Maholchic often spends time in this room, so he can look outside the window and feel the sun, since he cannot tolerate going outside during the day. He says that he spends most of his time reading and painting. Kayana Szymczak for STAT

“What even most auditory scientists don’t understand about hyperacusis with pain is that the pain lingers long after the sound is gone, much as the pain from a flesh wound would,” said M. Charles Liberman, a professor of otology at Harvard Medical School and director of a hearing research lab at the Massachusetts Eye & Ear Infirmary.

The problems start with the pea-sized cochlea, a tiny sensory organ buried within a skull bone. It’s tough to reach and impossible to biopsy, thereby hampering experimental work. Within the cochlea, one kind of nerve fiber has long puzzled scientists. These mystery fibers resemble pain fibers elsewhere in the body.

It took 15 years, but using several strains of deaf mice, Jaime García-Añoveros, an associate professor of anesthesiology at Northwestern University Feinberg School of Medicine, found that intense noise causes activity in these fibers. That research, coauthored by Liberman, was published last March in Current Biology.

At around the same time, a lab at Johns Hopkins University found that when certain sensory cells of the cochlea are damaged, as might occur during very loud noise, they release a chemical that activates the mysterious pain fibers. In some people, these fibers seem to switch on — and never switch off.

Noise loud enough to cause immediate pain — like a gunshot or a firecracker going off at close range — is so rare that few people ever experience it, except those in the military.

But exposure over time to more modest noise — from music, movies, sirens, lawnmowers, and a thousand other everyday things — can damage hearing and set off the pain fibers.

Indeed, noise can cause damage even if it doesn’t feel uncomfortably loud in the moment. “Young people don’t report a rock concert as a painful experience,” said Paul Fuchs, a professor of otolaryngology at the Johns Hopkins University School of Medicine, whose research was published in the journal PNAS in November.

Individual susceptibility to noise exposure varies greatly, and may be genetic. There’s no firm estimate of how many people may suffer from noise injury.

Hyperacusis
Maholchic’s collection of noise reduction earmuffs. Kayana Szymczak for STAT

Few doctors or audiologists are even aware of the condition, though the new findings may encourage them to take patients who complain of ear pain more seriously. “It is time for pain hyperacusis to be recognized as a real symptom, not as a psychosomatic phenomenon,” García-Añoveros said. “This is, in a way, a new sensory modality — a hybrid of pain and hearing.”

For Maholchic, the pain came on abruptly and quite unexpectedly. He never thought his noise exposure was at all unusual. At his student job at the University of Massachusetts, he listened to music on his iPod while he vacuumed. He played in a garage band. Later, he worked at a loud, lively restaurant.

His only symptoms were ear fatigue after band practice and bursts of discomfort from clanking dishes at the restaurant. These warning signs, seemingly inconsequential, quickly resolved.

One night two years ago, however, his ears started ringing. Within weeks, “barking dogs, crowded places, and pretty much any noise considered remotely loud sent shockwaves through my head,” he said in an interview conducted by email, since he must limit his time on the phone.

Maholchic had been living in California, but moved back in with his parents in suburban Boston because the pain was so debilitating. To cushion him from noise, the house has soundproof windows and plenty of carpeting. Maholchic also sometimes wears earplugs or protective earmuffs. And he rations his time spent in potentially painful settings. “If I manage my noise exposure well, I can handle noise better,” he said.

Maholchic has improved enough to be able to take occasional late-night walks while his neighborhood sleeps. But just one surprise noise, like a honking horn, erodes his progress.

“The louder the noise, the greater the impact,” he said. “It angers me to think about all the unnecessary noise I exposed myself to. I was unaware of the harm it could cause.”

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  • This is an interesting post.
    I have had pain in the ears on loud noises for 5 years. It’s been diagnosed variously as tinnitus and hyperacusis. This is an interesting article as it focusses on the pain. Sure I get the ringing and it’s loud and distracting – and I wish I didn’t have it. However, I can ignore it. The pain I cannot ignore. If I ride in certain cars, at the time I don’t really feel anything at all out of the ordinary. Then over the next 24/48 hours I get ear fullness and sharp constant pain which spikes on loud noises – hypersensitivity with severe pain. Gradually, over time – say 1 week it subsides leaving me only with the tinnitus.

    So some observations……..

    The pain starts at least 18 hours after the noise which I would say has caused this. There’s always a trigger to make this worse. Why after, not at the time?
    It’s accompanied by ear fullness.
    The pain is not near my ear, it’s in my ear- deep inside it.
    Swallowing gives minor relief – sort of feels connected to the pain site.
    I can pop my ears.
    No pain killers touch it.
    For me, much worse in right ear.
    Sound Therapy pointless as its not an awareness thing – it’s real pain!
    The medical profession I’ve consulted don’t really believe these symptoms and in what I would describe as astonishing arrogance, tell me I don’t feel pain but I only think I have pain …….. So if you don’t know what it is, it must be that the patient is wrong about their symptoms.
    The noise in cars (which is the single worst thing for me) might be vibration as much as noise – ear plugs don’t always stop this!
    It’s better when I first wake up.
    Worse the first day it starts and then diminishes so almost feels like part of a “healing” process.
    I’ve tried ear grommets – make no difference.
    Sometimes when I take hay-fever tablets it feels a little better.
    I have good hearing – as tested by audiologist – very good in fact.
    If it’s very bad, I get a stiff neck also.
    It’s not all loud sounds that kick this off.
    I’ve had several sports cars. If I’m track racing – never a problem, even without ear plugs but I have a helmet on- maybe the sound gets in via bone conduction and it’s that which causes the issue?
    Noise cancelling headphones no good – simple plugs better.

    I’d be fascinated if there is any further serious reading on this topic. I’ve tried to set out some of the things I’ve noticed about my condition but this might not be the same as other people’s. I’d read anything,particularly anything which contains real understanding and practical ways to manage this condition or pain management suggestions I search the net on various search headings almost daily and this is the first time I’ve ever seen anything focussing on pain – which for me is the difficult bit to tolerate.

    Thanks

    J

  • Hyperacusis is treatable for many people. I have hyperacusis. Sound therapy is very helpful (tinnitus re-training therapy, or TRT) to many people including myself. You can read about it here:

    http://www.hyperacusis.net/

    Some people make a full recovery, others can recover enough to live a mostly normal life.

    The difficult thing about hyperacusis, is that excessive noise exposure will rapidly worsen it. The even more difficult thing about hyperacusis is that not enough noise exposure (ie, wearing earplugs all the time etc) will also make it worse. Gentle noise exposure, increasing over time helps desensitize the auditory system. Treatment can be extremely frustrating, but there is hope.

    I wear sound generators all day which emit quiet broadband sound, as well as do therapy by listening to noises at slowly increasing decible levels. It does work for me.

    Your article should discuss hyperacusis treatments. Even though the initial cause may indeed be ear damage, as discussed in the article, the brain can slowly learn to compensate and stop sending signals of loudness or pain inappropriately.

  • the search for relief went to the U.S.A about 34 years ago. Leading onto London 27 years ago – back home to South Africa. The answers to the diagnosis of tinnitus helped. The cause and cure(s) are unclear , and I am told remain so.

  • I’ve had a Quaker parrot for almost 2 years in August. As the baby grew so did its sounds. Lol
    2 weeks ago the bird named Jemma got excited as she does sometimes and loudly screeched a happy screech in my r ear. She of course was on my shoulder. I experienced a very sharp pain in my ear. Ever since this occurred my ear feels full of pressure ( like water in the ear with no swish.) I also get a knife stab like pain off and on which makes me scream. This comes and goes along with a noise like an ear test makes….eeeeeeeee. Is my ear damaged. You were the only one I could find to explain this. All other things on google regarding ears said ear infection ect. Should I see an ear doc to or will this go away … Thank you so much for your article.

    • I had a similar experience. A sudden loud car honk near me gave me a stabbing, throbbing pain in my ear that has persisted for almost a day now. I feel in pain and am concerned that damage has been done.

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