– by Ira Kraemer (@AspieHuman on twitter)
 

[There have been lots and lots of follow up questions in response to Ira Kraemer's excellent talk on Hyperacusis and Auditory Sensitivity for Virtual Summit this year. In response to this STAR Institute asked them if it was possible to put some of the answers in the same place - on a guest blog post - and we are so glad that Ira agreed!]

So, there is no real truly effective "hyperacusis treatment." There is especially no true effective treatment for autistic people. This is something that hasn’t been researched especially in the autistic population.

If you already have hyperacusis, viruses/infections can exacerbate this. If you notice very clearly worsening of hyperacusis after being sick, please have the autistic person be checked by an ENT for other issues, such as hearing loss or fluid in the ear.

Here's the thing - the current neurotypical treatment for hyperacusis is low white noise sound generators. I have hyperacusis and I can't deal with even very low levels of white noise. Also, it is really not researched enough to be shown to be effective. It's a very "individual trial" thing.

As an autistic person with hyperacusis, I would not try this treatment. This may make the child’s hyperacusis even worse (they even warn about that to neurotypical people trying the treatment who have hyperacusis).

There is a lot of fear about hyperacusis or auditory sensitivity getting "worse" when wearing hearing protection, in particular the fears of parents, and if that's what you're concerned about - well, there's really not research either showing that this is true or not at all. There's no research showing this is true that I know of, just kind of an assumption by researchers for some reason. There needs to be more research about this, but personally that’s not something I experience. Personally I have not experienced my hyperacusis getting "worse" by using ear protection.

I do however usually just wear my headphones, which is maybe a 10-15 dB SPL sound reduction, which is about the minimum reduction I need for existing in the world outside. If things get louder though and I need to switch, I will switch to wearing just the earplugs. For going to a conference, convention, or concert, I must wear both Earaser earplugs and headphones almost at all times to reduce the sound level and prevent ear pain. The combo works surprisingly well for me currently.

Ear Protection Quick Tips*

• Personally I found the best earplugs to be Earasers, at the highest 31 dB SPL reduction filter (they’ve since added an even higher filter at -36 dB SPL) - www.earasers.net/
• The headphones I use, are passive over-the-ear noise reduction, bluetooth headphones by Mpow
  These head phones work by filtering out high frequencies, and they help reduce loud white noise sounds as well.
  (Be careful if you’re using the Bluetooth because the “bluetooth on” sound is quite loud. So I don’t use the Bluetooth on the headphones. I also don’t listen to music with them for my hyperacusis, I just wear it to block the sound. Other people might find listening to quiet/soothing music helpful but I don’t find it helpful).
• Try a combination: I'm also able to wear the Earaser earplugs under these headphones comfortably when I have to go to events with a lot of people, which is the other reason I really like the Earaser earplugs. This combination lets me attend conventions and concerts, and I can still hear the person who’s talking to me.
• I originally purchased Etyomic earplugs which are cheaper (musician earplugs, about $13 on amazon), slightly more uncomfortable, but have similar filtering properties. It might be worth getting those to see if those types of silicone earplugs would work for the autistic person.
  The other thing you can get is actually a customized earplug for them, you can get a mold set online (such as from the Etyomic website), or an audiologist can make a mold for you. I haven't done this, but some other autistic people have and like their customized earplugs. They can also change out the filters if they need more or less sound reduction.
• For some people noise-canceling headphones make things WORSE because when you are wearing them you can hear the mid-high frequencies even more clearly, and it only drowns out/muffles the low-frequency sounds, which does not help. I would assess the quality of the noise-canceling headphones if they’re not working for someone, as sometimes they play white noise which actually makes things worse. 
• You might want to try ear defenders as well. You are looking for them to really cover your ear and be comfortable (the same with over-the-ear headphones).
• There are some higher-end noise-canceling headphones it might be worth looking at such as the Bose and Sony higher-end brands.
  Bose recently started selling some "hearing aids" called Bose Hearphones that have a noise-canceling feature and I do wonder if it would be helpful in cases of hyperacusis, but I don't know. They don't always amplify the sound, I think you can try to reduce the sound as well. They put a lot of effort into the noise-canceling feature of the device.
• The other set of earplugs I have are Flare Audio metal earplugs with foam eartips, which are the most uncomfortable (I have small ear canals and the foam tips even for XS size is pretty big) but also are pretty effective, probably the most effective, but it can be hard to hear what people are saying. I manage to hear people still though because I have very sensitive hearing but some people may not be able to hear things with those earplugs. Also it makes your voice sound really loud while you’re wearing them (I wouldn’t eat food with these in).
• Also, wearing earplugs at the dentist will make cavities being filled VERY UNPLEASANT because it increases bone conduction, so it makes things louder. Just as a warning. I may have tried this without thinking about it and had to take my earplugs out during the procedure.

*None of this advice should take the place of seeking professional medical and therapeutic advice which is always recommended in response to any pain or discomfort.

After checking with an ENT if needed, I would also have them do at least 1 occupational therapy session to get a sensory profile assessment. Figure out what types of sounds are an issue, what frequencies, and what sound levels. Unfortunately, most audiologists aren't well-versed in hyperacusis and won't have a specific understanding of hyperacusis in autistic people. 

Links to Everything:

• Earaser earplugs 

• Bluetooth passive noise reduction headphones by Mpow

• Etyomic earplugs

• Bose Hearphones, Bose and Sony noise-cancelling headphones

• Flare Audio metal earplugs

• Auditory Conditions: Hyperacusis, Hypersensitivity, and Gaslighting of Autistic Lived Experience (Ira Kraemer) - webinar

The views expressed in this guest blog post are those of the author and do not necessarily reflect those of STAR Institute.