What are the options for dealing with hyperacusis and hearing loss?

As previously indicated hyperacusis is a very delicate situation.  Even the standard test procedures need to be modified to accommodate possible discomfort felt by the patient.  As an example, one procedures is the "Acoustic Reflex Test", which is literally designed to play loud beeps until we detect an acoustic reflex in the muscles of the middle ear.  In my own experience, this test is very uncomfortable for most hyperacusic patients.  If we can complete it, however, it does provide additional useful information for both diagnostic and, if appropriate, amplification purposes.  Another test procedure should be completed to find the specific levels where sound is uncomfortable, preferably on a frequency-by-frequency basis.

Regarding amplification, patients with hyperacusis also often have hearing loss and tinnitus as well, so we need to find some way to treat everything (i.e. rock and a hard place).  The trick is to provide enough amplification without hitting the patient's discomfort level.  Most hearing aids have a feature known as "Maximum Power Output", or "MPO", which is the loudest the hearing aid can get at any given frequency.  This is to prevent overamplification and protect the person's hearing from additional damage.  This feature is adjustable, and generally I program the aids, if possible, down to below the patients uncomfortable level (determined during the diagnostic testing described above), so that the hearing aids can never get into the range where the patient finds it uncomfortable.  This is further verified through the use of probe microphone measures, where I verify the hearing aids are performing to their programmed specifications by measuring the actual output of the hearing aids in the ear canals themselves.

In addition, we also need to provide some protection against outside loud sounds that can enter the patient's ear canals naturally.  The hearing aids might be limited in output based on their programming, but loud sounds can still get in the natural way.  Because of this, I will normally fit the patients with earmolds that occlude the ears so that they are effectively working as earplugs but sound is filtered (and limited) by the hearing aids.  All of these efforts combine to provide the patient with better communication abilities while limiting the exposure to loud sounds.

We don't stop there, however, as treatment for hyperacusis should be looked at as therapy rather than just purchasing an appliance.  A good treatment plan will include long-term follow-up and adjustments to help habituate the patient to reduce the effects of the hyperacusis over time.  Sound therapy is utilized, basically exposing the patient to controlled sounds on a regular basis to habilitate the brain into accepting sound more.  Likewise, the MPO on the hearing aids should be slowly raised over time.  Likewise, a patient may eventually graduate to having less occluding earmolds so that they can also learn to tolerate the natural loudness of their environments.  

With proper treatment and follow-up, hyperacusis can often be reduced and potentially eliminated, but every case is different.

Each case of someone dealing with hyperacusis and hearing loss is highly individual.  The treatment plan and options vary greatly but usually include delicately treating the hearing loss with amplification while helping to overcome and treat the hyperacusis.  It's critical to work with an audiologist who specializes in treatment of both hyperacusis and hearing loss.  This process should begin with a comprehensive hearing evaluation and consultation.  

Higher end hearing aids process sounds faster to help reduce the amount of uncomfortable noises even if the dynamic range is limited.

Many people who develop hearing loss also become more sensitive to loud sounds thus reducing their dynamic (useable) hearing range from both ends.  We need to provide amplification to offset the hearing loss but don't want to provide so much that sounds become uncomfortably loud.  Part of the testing process includes discrete uncomfortable level testing (done using individual frequencies).  This gives us a ceiling for sound loudness that can then be programmed into the hearing aids to cap their maximum output at or below the patient's maximum comfort level while still providing enough amplification for the patient to have near normal hearing.  The hearing should be rechecked once a year including the uncomfortable levels and the hearing aids adjusted accordingly if there has been any change.

Excellent question!  Hyperacusis is certainly an issue when trying to get hearing aids to perform at peak efficiency.  I've been relatively successful with patients that understand the issue and are willing to work toward an end.  There is no quick method of treatment that I'm aware of and it must be understood that over time the issue can be lessened, possibly cured.  After finding the levels where sound becomes uncomfortable, I set the aid output to not exceed this level. This alone takes time as each frequency must be adjusted to assure sufficient volume without exceeding the pain thresholds.  Reduced volume does restrict the performance of the aid and negatively impacts the immediate gain toward hearing.  However, after multiple weekly visits and gradual adaptation to increased sounds, both the hyperaccusis and the hearing loss can be improved.  Again, it takes time and patience but I've not had a case yet that hasn't seen satisfactory results.  Work with your provider knowing that the issue is treatable but of longer term.