A note from Anna: My friend and Ear Surgeon Joe dropped me a message one day after reading something I’d written on how the noise I’m so often surrounded by as a parent drives me a bit wild! Sometimes even the happy, playful squeals of my kids can evoke a reaction in me that feels like stress or rage! He offered to give us a bit of insight (or, earsight, chuckle), into why this happens, and what we can do to help ourselves in those moments.
It’s a pleasure to contribute to Anna’s page. We met 10 years ago through our friend Kathryn, before Instagram was much of a thing! It’s been wonderful to see what a source of inspiration and support she has become to so many young parents and we have her books on our shelf! I am an ear & hearing specialist doctor and surgeon for adults and children, working in central London. I see a whole range of conditions, some of which need procedures and surgery but also many which benefit from parallel therapy. I’m also a Dad of (soon to be 2!) and share plenty of insights from my working and parenting life at @earsurgeonjoe
“The benign sound of my kids slurping or breathing heavily makes me wince and want to leave the room. I keep being triggered by harmless pen-tapping and chewing and I don’t know why…. Should I be a better parent than this? Is there something wrong with my ears?”
When a sound triggers an excessive emotional reaction, it may not be a problem with your ear or the sound itself, but rather a disordering of the way the sound processing parts of your brain are communicating with each other.
Although many people who suffer with this phenomenon subsequently develop feelings of frustration, resentment and guilt, it’s helpful for us to understand that experiencing extraordinary sensitivity to sound is part of a spectrum of legitimate recognised conditions.
Misophonia is where certain sounds trigger an emotional or physiological response that is out of keeping with what might be considered reasonable. Sounds can appear quiet to others but induce anger, rage, panic, fear or avoidance in you. Oral sounds seem to be common triggers – swallowing, chewing & breathing, as are repetitive sounds – keyboard tapping, windscreen wipers & fidgeting fingers.
Hyperacusis is an increased sensitivity to sound and a lower tolerance for environmental noise, that results in physical discomfort. Again, these are sounds that are otherwise easily tolerated by others, and discomfort if frequent, can lead on to wincing, distortion and subsequent distress. Sounds can be perceived louder than they are to others.
Think of Misophonia as more of an emotional triggering and Hyperacusis more of a physical triggering.
Phonophobia by contrast is a greater than usual aversion to loud sounds. This can induce fear and avoidance of devices that emit loud sounds such as fire alarms, whistles and speakers. Anticipating a loud sound, such as when you see a balloon being slowly over-inflated, can induce real fight-or-flight symptoms. Headache and migraine overlay are common associations.
Take a look at this diagram of the auditory pathway. Hearing, listening and understanding are three different things that happen in different parts of our neuroanatomy. The auditory cortex (responsible for processing sound into something understandable), the brainstem (the brain’s ‘headquarters’ responsible for breathing, blood pressure, heart rate and sleep) and the limbic system (responsible for regulation of emotions) are all inter-linked, and constantly firing back and forth between each other. This complex interplay leaves many different places in the pathway for things to malfunction.
Research into the cause and treatments of misophonia and hyperacusis is still evolving, and despite our recognition of these conditions there’s still much that needs to be discovered about the neurobiological mechanisms. Until then, we need to focus on the broad principles of managing neuropsychological conditions, including breaking cycles and improving brain health.
The same advice you will usually hear about sleep, exercise and nutrition is all beneficial here. Any young parent knows those are not always simple to put into practice. Anna already has a wealth of information on managing anxiety and improving the health of your mind – all of that is relevant here and I won’t repeat the same content. But instead, I am going to highlight 5 things pertinent to my field which are helpful to know and that I often cover with people coming to see me.
- Think about your daily cognitive reserve and how to preserve it. Your brain spends all day processing the inputs of all your senses – vision, hearing, smell, taste & touch. When one of those senses is working at half-capacity, for example if you have a hearing loss or visual impairment, then your central processing has to work twice as hard to fill in the gaps whilst still filtering what’s important to you.Imagine a day without your contact lenses – you can strain for a while but you’ll soon feel knackered. The same is true of hearing and auditory processing. If you have undiagnosed hearing loss, there are things that can be done (procedures, surgery, hearing devices) to reduce your listening effort and reduce your cognitive load. Reducing background noise and enabling audiovisual cues such as lip reading (made difficult by the world of masks) and captions can have the same beneficial effect. Unfortunately there remains a societal stigma around making your hearing problems visible to the world, that doesn’t exist in the same way for people who wear glasses for their vision. Chipping away at that stigma is one of my career missions!When your cognitive reserve is low, your emotional reaction is further heightened. That emotional reaction may be anxiety, anger, rage. So what you tend to do is…avoid. Avoidance then leads to anticipatory fear, and a perpetual cycle which makes triggering sounds even more triggering. This further increases your cognitive load and down the line, you’re unable to function at the same pace you once could. Instead we need to remember that the sounds aren’t the problem. Break the cycle of sound avoidance. Shift the focus to increasing your cognitive reserve. Stop that cup from draining before the day is done. A study in 2013 in Sweden examined 140 men & 208 women and found that women with high levels of emotional exhaustion became more sensitive to sound after an acute stress task.
- Don’t feel shame or stay silent if you’re experiencing misophonia. Share it with a health professional or at least someone you trust that cares about you, before it ends up making you isolated. Hearing health and its emotional sequelae are just as important as any other aspect of your mental health. It deserves validation and care. Cognitive behavioural therapy is a strategy to help sufferers regain control. By examining why and how you experience symptoms opens opportunity to change that pattern and reduce impact. Counselling, sound therapy and mindfulness are all avenues to explore.
- If you have specifically one-sided symptoms or if you have other concurrent ear and neuro symptoms including tinnitus, hearing loss, facial weakness or numbness or the sensation of hearing footsteps or your eyes rolling – then see an otologist (an ENT doctor specialising in ears, which is where I come in). There are some things that need ruling out depending on your examination findings and hearing test. Noise-induced inner ear disease, Lyme disease, Ménière’s disease, superior semicircular canal dehiscence syndrome, perilymph fistula, facial nerve palsy and certain medications and psychoactive drugs can all be an underlying cause of hyperacusis.
- Take advice before using any device you see advertised online designed to tamper with your ears. Ear wax is a topic millions of people are fascinated with and people are out there to take advantage of this. As an ear surgeon I perform delicate procedures in the ear that involve being a millimetre away from causing permanent harm. It really alarms me how much unregulated tech is allowed to be sold online without any evidence base. A healthy ear is meant to produce wax and should self-clean without you needing to do anything. Wax isn’t dirty – it’s your ear’s way of protecting itself from infection. It only needs to be removed if there’s pain, hearing loss or a diagnosis needs to be made – otherwise you can leave it alone. DIY wax removal cameras might look appealing but aren’t good enough to safely be able to remove deeper impacted wax – the stuff that actually does need removing. Microsuction by a professional is the only safe and effective way you should have your wax removed. Oh, and ear candling is a complete social media illusion – avoid!
- Finally be aware that sudden hearing loss is an emergency that has a time-critical window for assessment and delivery of steroid rescue treatment if the inner ear is involved. Not everyone knows this! Many people still miss the boat for treatment, through lack of awareness or putting it down to a cold or wax, which sometimes can be quite devastating.
Joe Manjaly FRCS (ORL-HNS)
Consultant Otologist, Auditory Implant & ENT Surgeon
The Royal National ENT & University College London Hospitals
Ear & Hearing Specialist Doctor & Surgeon
One Welbeck ENT, London