Noise Hyper-Sensitivity in Kids

Although we mainly see kids for hearing loss due to fluid in the ears, chronic ear infections, or eustachian tube dysfunction, every so often, a child will show up with the exact opposite problem.

The child hears just fine, but suffers from noise hypersensitivity, also known as auditory hypersensitivity. Such children are overwhelmed from everyday noises whether doorbells, sirens, key clanking, etc; typically high-pitched sounds. The hands will go over the ears in an attempt to dampen the sound and may even become tearful.

This phenomenon is not uncommon in kids with developmental delays, autism, central auditory processing disorders (CAPD), Down's syndrome, etc. But "normal" kids may suffer from this condition as well.

Before going into treatment, one first needs to understand how sound is perceived first.

Human hearing is a complex listening device composed of not just the ability to "hear" the sound, but also to "comprehend" the sound. Disorders like CAPD is analogous to dyslexia where the patient can "hear" sounds perfectly normally, but has trouble understanding what they hear.

As a child develops, the auditory neural pathways in the brain that govern the comprehension of sounds are either reinforced or dampened down with time. For example, auditory neural pathways that allow for speech comprehension are reinforced whereas neural pathways perceiving background noises and other random sounds are dampened with time.

In auditory hypersensitivity, for whatever reason, the auditory neural pathways governing the perception of certain miscellaneous noise like sirens or doorbell are reinforced causing the perception of the sound to be more significant and tremendous than it should be. In a normal child without sensitivity, such pathways are suppressed.

To use an analogy, consider the auditory neural pathway like the road system in the United States. Over time, certain roads like the interstate highway is "reinforced" leading to more drivers using such streets to get from point A to point B far more quickly than if they used local roads. Problems occur if for some reason, cars avoid the highways and local roads are taken preferentially leading to traffic jams and irate drivers.

Auditory hypersensitivity is kind of like that... local roads being "reinforced" when it should be suppressed.

So what can be done to treat this frustrating condition?

In essence, therapy is geared towards reinforcing good auditory neural pathways and suppressing the bad ones that lead to noise hypersensitivity.

Such therapy programs include listening to special music and ear training exercises. One such program is "The Listening Program".

But one thing is clear... keeping someone with noise sensitivity in silence is the worst thing that can be done. It just reinforces the bad pathways!

Of course, there are other causes of noise sensitivity:

1) Migraines (children may not exhibit the class head pain, but they still can suffer from noise sensitivity)
2) Cochlear hydrops (if associated with hearing loss, tinnitus, sound distortion)

Why Does My Voice Sound Different on Recording and Treatment Options

Every so often, I have a patient who presents to my office with a complaint that their voice sounds different on recording than what they themselves hear.

In particular, singers who come in state specifically that their vocal recordings sounds slightly flat when they thought they were singing in perfect pitch.

So why does this happen? Unfortunately, it is physics and fundamentally integrated to how the ear, skull, and sound transmission work. In other words, it can't be "treated" with surgery or medications.

What other people hear when you sing or talk is air conducted sound that gets transmitted through the ear canal, eardrum, middle ear bones, and ultimately to the cochlea hearing organ (pathway A). Image modified from Wikipedia.

The sound the individual singer/talker hears is not only sound transmitted via the air (pathway A) but also by vibration of the skull itself directly to the cochlea hearing organ bypassing the outer and middle ear completely (pathway B). The mechanical properties of the skull enhance the deeper, lower-frequency vibrations.

Therefore, when a talker/singer listens to a recording of their voice speaking/singing, the bone-conducted pathway that they consider part of their “normal” voice is eliminated, and they hear only the air-conducted component in unfamiliar isolation (what everybody else actually hears).

SO... what is a singer/talker to do if they are disturbed by the way they sound to others? Particularly, what is a singer to do when they always sing a little flat when they truly think they are singing in pitch?

One can wear earplugs in order to hear only bone-conducted vibrations and get used to their alter-voice and undergo speech/voice therapy. OR... accept that their voice IS different.

For singers, I highly recommend using HearFones Headsetwhich is a funny looking head device that allows an individual singer to hear what they really sound like and more importantly what the audience would hear! In addition, while using HearFones, the singer would be able to hear himself more predominantly over the rest of the ensemble thus helping him to improve the quality of his/her individual vocal quality output.

Over time, singers will be able to automatically adjust their singing such that they no longer will need such a device to sing in tune with others when in familiar surroundings. BUT... in new environments (new concert hall, outdoor arena, etc), it is not unusual that their singing may become off again...

This is why professional singers often wear earpieces that convey sounds recorded by microphones placed in the audience... and also why they sometimes sound flat and out-of-tune when they don't!

It's also why it is VERY important to rehearse in a new place before a concert.

Voice Sounds Different After Tonsillectomy and/or Adenoidectomy!

Every so often, I hear a parent state that their child's voice/speech sounds "different" after undergoing tonsillectomy and adenoidectomy. Beyond sounding less nasal which is expected, the other comment is sounding higher pitched or more feminine.

This observation is especially true when dealing with a male school-age child.

The reason for this voice (or really speech) change is because the upper airway is much larger and more resonant after the tonsils and adenoids are removed.

Just like a person's voice sounds different when talking in a closet versus a large auditorium, the larger opening through which the voice travels after surgery is much larger than before and as such, the voice/speech has to correspondingly change after surgery as well.

The change is also much more dramatic the larger the tonsils and adenoids are.

SO, do not be alarmed if your child sounds different after surgery, especially if the tonsils and adenoids were extremely large. It is actually an expected occurrence and not an indicator of anything bad, swelling, healing, etc.