Diagnostic Imaging

When hyperacusis symptoms first develop, it is important to consider imaging early, ideally before symptoms become too severe to tolerate medical procedures. Early CT imaging provides crucial information that can guide management before hyperacusis becomes debilitating.

In particular, a high-resolution CT scan of the temporal bones is strongly recommended as soon as possible. This study can exclude structural conditions such as superior semicircular canal dehiscence (SSCD) and other middle or inner ear abnormalities that may cause or worsen sound sensitivity.

Because hyperacusis can progress rapidly in some individuals, patients may later become unable to leave their homes or tolerate medical environments, making imaging much more difficult or impossible.

MRI can occasionally help rule out nerve or brainstem causes, but it is generally avoided in people with hyperacusis because MRI scanners are extremely loud (often exceeding 90-100 decibels) and can significantly aggravate symptoms.

High-Resolution Temporal Bone CT

Performed for evaluation of hyperacusis, noxacusis, TTTS, MEM, and tinnitus.
Ultra-thin slices (typically 0.5–0.6 mm) for high spatial resolution.
Field of view focused on the temporal bones.
Non-contrast imaging is generally sufficient.
Multiplanar and 3D reconstructions aid assessment of ossicles, cochlea, semicircular canals, and mastoid air cells.
Helps identify structural causes and supports both conservative and surgical management planning.

High-resolution temporal bone CT is a very common study and nearly every hospital and imaging center has a standardized protocol for this exam. Any ENT specialist should be able to order this exam, however, after the imaging is completed you will likely need to find, or be referred to, a highly-specialized ENT (otolaryngologist) or neurotologist with experience treating hyperacusis ─ ideally with expertise in the Silverstein Procedure.