Sensitivity to sound, often referred to as auditory defensiveness or hyperacusis, can be a socially isolating condition hindering social participation for many of our clients or students. The Friendship Circle identifies different types of noise sensitivities as described in the online post, “Noise Control: 11 Tips for Helping your Child with Autism Deal with Noise” (Wang, 2014). Causes of hyperacusis are varied and may be due to neurological, otological. congenital, endocrine, medication among others (Hyperacusis Focus – Causes, 2019). As an occupational therapist, we often have many students exhibiting the symptoms of sensitivity to sound requiring intervention to assist with reducing isolation, avoidance or behavior challenges.
Treatment of hyperacusis is varied with severe cases requiring medical intervention and counseling (Hyperacusis Focus – Ear Plug Use, 2019). Other treatment methods can include desensitization, avoiding exposure, use of electronic hearing devices or noise cancelling ear protection as well as alternative treatments for stress reduction and symptom management (Hyperacusis Focus – Causes, 2019) (Wang, 2014).
As an occupational therapist in the school system a typical method of intervention is using noise cancelling ear muffs. Noise cancelling ear muffs are readily available, low cost, and can be independently applied by the student on demand. A wide variety of noise cancelling ear muffs are available that are affordable (see list or link below). Noise cancelling ear muffs however are not discreet in appearance, especially when used in the classroom where peers are not permitted use.
Student Case Study
A middle school student I work with has a long-standing history of sound sensitivity. Ear muff continue to be needed for him to comfortably participate in assemblies and join peers in the cafeteria. Results of a sensory processing assessment indicated he still falls in the “more than most people” range in sensory sensitivity and avoiding, with noise a major factor. As a middle school student transitioning soon to high school, exploring other discreet options that will continue to allow him to participate in school activities with his peers. Exploring options of noise reducing tools was discussed with his teacher and the student for self esteem and social acceptance as he transitions to the secondary level.
Noise Reduction Ear Plug Trial
One solution immediately trialed was providing him with a set of Vibes High Fidelity Noise Reduction Ear Plugs previously purchased and identified as a noise reduction tool used by individuals with autism (Lamb, 2018). While high fidelity noise reduction ear plugs are used by musician and employees who work with equipment or environments with loud and continuous noise, these noise reduction ear plugs also are known to support individuals with noise sensitivity. Noise reduction ear plugs decrease sound levels (dB), filter specific frequencies while maintaining the ability to hear and the quality of the sound. High fidelity noise reduction ear plugs each have different levels of sound reduction identified by the manufacturer and are just one of many types of sound reduction ear plugs available (sleep, work, shooting, flying, music, etc.) (Banks, 2018). Noise reduction HF ear plugs for musician are generally recommended for individuals with hyperacusis. The Vibes HF Ear Plug offer noise reduction up to 22 dB and come with different sized replaceable ear tips. Use of these types of noise filtering earplug, depending on the user, could also help grade exposure to sound, allowing some noise but filtering out louds sounds to help individuals with sound sensitivities increase their tolerance as recommended (Hyperacusis Focus, 2019).
The trial of the Vibes with the student was successful. He was motivated in using the low-profile ear plugs and applied them consistently during his school day to join peers at lunch time in the cafeteria. On a rare occasion he sought out eating in the resource room due to high noise and a report of “whistling sounds” with the noise level. This may be the result of a poor fitting ear tip or certain noise levels particularly challenging to his auditory processing. Although the Vibes have successful for the student, additional research on options for this student continued for this trial period.
Resources on Hyperacusis and Ear plugs
Helpful information about sound sensitivity and ear protection was found at in the following articles and websites:
- Lindsey Banks, Au.D. ‘s online article “The Ultimate Guide to Wearing (and Choosing) Ear Plugs”, (Banks, 2018). Her updated post provided great information on different kinds of ear plugs, purposes and a listing of “Best” earplugs in each category.
- Hyperacusis Focus.org provided an excellent overview of the condition of hyperacusis. The concept of discouraging overprotection or over use of hearing protection was presented with evidence that it will lower loudness thresholds over time (the more you protect, the greater the sensitivity over time) (Hyperacusis Focus – Ear Plug Use, 2019). This evidence is similar to the recommendations for light sensitivity, the more you protect the greater the sensitivity and anxiety about exposure. Slow, graded exposure to sound is important to improve tolerance generally. This is typically evidenced with our students as they age.
- “Noise Control: 11 Tips for Helping your Child with Autism Deal with Noise”, written by Karen Wang provides types of sound sensitivities, strategies for the condition, interventions as well as alternative treatments for the condition.
This general information provided good background information from a general viewpoint.
Ear Protection Options
Research and experience with noise cancelling ear protection identified the following ear protection options. There are many options on the market with the following being just a few gleaned from research:
Ear Muffs: Over the ear headsets or ear muffs are a handy, durable solution for individuals with sound sensitivities. A wide variety of headphones are readily available for children and adults in stores with sporting goods and sound equipment. Here are just a few ear muff recommendations:
High Fidelity Ear Plugs:
- Etymotic HF ER 20 Earplugs – (12.95) One pair, available in two sizes available (Large and standard) with 20 dB NNR.
- Etymotic HF Earplugs (ER20X; $19.95) High fidelity noise reduction ear plugs. Reduces nose by 20 dB. Available in large and standard size.
Some noise reducing earplugs comes with a case. strap or neck cord to help with maintaining and locating these small earplugs.
High Tech Noise Reduction Earplug Option
Other options for noise reduction include high tech active noise cancelling earplugs which have a microphone and a processor that produces anti-noise to cancel sounds. These earplugs are expensive with costs in the $300 range. An option to explore include the active noise cancelling earplug technology produced by QuietOn.
Summary: Low profile ear plugs are available to reduce noise levels for individuals with sound sensitivity, however, may be dependent on the users sound sensitivity, fit motivation and safety with use. Many options are available for ear protection, with standard ear muffs readily available and high-fidelity noise reduction earplugs which reduce certain levels of sound. High tech active noise cancelling ear plugs are also available at a much higher cost. Recommendations were found suggesting limiting overuse of noise cancelling ear protection which may contribute to reduced sound tolerance when used for a long period of time. A variety of intervention methods and strategies including medical, counseling, therapies and devices are available for individuals with sound sensitivities.
What other experience and recommendations do you have for noise cancelling headsets or earplugs?
More for your OT and AT Tool Kit!
Carol
References:
Banks, L. (2018, May 8). The Ultimate Guide to Wearing (and choosing) Ear Plugs. Retrieved from Everyday Hearing: https://www.everydayhearing.com/hearing-technology/articles/ear-plugs/
Hyperacusis Focus – Causes. (2019, February 3). Retrieved from Hyperacusis Focus : http://hyperacusisfocus.org/research/causes/
Hyperacusis Focus – Ear Plug Use. (2019, February 3). Retrieved from Hyperacusis Focus: http://hyperacusisfocus.org/other/
Lamb, E. (2018, February 19). Vibes High-Fidelity: EarPlugs for Autism and Sensory Processing Disorder. Retrieved from The Autism Cafe: https://theautismcafe.com/high-fidelity-earplugs-people-sensory-issues/
Wang, K. (2014, May 6). Noise Control: 11 Tips for Helping your Child with Autism Deal with Noise. Retrieved from Friendship Circle: https://www.friendshipcircle.org/blog/2014/05/06/noise-control-11-tips-for-helping-your-child-with-autism-deal-with-noise/
Sells for $9.99 on Amazon. Adding a gripper to this stylus is possible for ease of grasp. See gripper suggestions below. This can be used with an iOS or Android tablet and may offer replaceable tips.
. For a precise input method, this mini stylus is a great price and writing control on a tablet.
Grasps are also available for the Apple Pencil improving the comfort of holding and manipulating or writing with it (see below). Grippers are available 
for Apple Pencil 2
These grippers can also be purchased in small quantities in each style. Cost is under $10.00 on Amazon.
foam tubing is a standard for building grasps of handles of tools or implements for individuals with strength or dexterity challenges. The foam tubing comes with different sized diameters pending the tool shaft and can easily be cut to any length. Cost is under $10.00 for a pack of 6 on Amazon. Tubing can be found in a variety of different sizes.
OT's with Apps & Technology 