After a recent flight back from Australia, all noise – from the TV to the sound of someone’s voice – suddenly became an unbearable din that was quite distressing. What could have caused it?

Pete Plenge, via email.

Dr Martin Scurr replies: This sounds very like hyperacusis, where ordinary everyday sounds feel uncomfortable, intolerable and, at times, painful. Even noises such as the sounds of using pots and pans in the kitchen, passing traffic or TV and radio can cause considerable discomfort.

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Those affected also often feel a sense of pressure in the ears.

While exactly what causes this hypersensitivity is not clear, it appears to involve some change in volume control as perceived in the auditory pathways to the brain: the simple result is that sounds are amplified.

Some people develop it after loud noise exposure, head injury, migraine or other ear and neurological problems.

It is more likely if you already have some hearing loss, as this then drives excessive amplification of sounds by the auditory pathways to the brain.

It seems very likely that your long flight from Australia a few weeks before the onset may be connected to your experience, especially as – in your longer letter – you also mention you were diagnosed in the past with Meniere’s disease, an inner ear disorder that affects hearing and balance.

It’s possible the combination of this with the long hours of ‘white noise’ from the jet engines, and the inevitable changes in air pressure when you fly, set you up for hyperacusis.

You are extremely fortunate that, as your letter also states, your symptoms cleared up on their own and without any treatment a short while later.

Many patients do improve in time with help in the form of cognitive behavioural therapy – which retrains the brain’s negative response to the noise so that it ceases to cause so much bother.

Sound desensitisation therapy can also help. This involves ‘white noise’ (such as static) played into the ears to gradually desensitise the brain to external sounds.

I have pain in my right big toe that comes and goes. It’s not gout and it’s not the big toe joint. The toe is slightly swollen. Pain comes on when I am walking – annoying, as it’s one of my hobbies.

James Barugh, Berkshire.

Dr Martin Scurr replies: I suspect it’s entrapment neuropathy, where a nerve that supplies a specified area (in your case your big toe) becomes pinched under certain conditions, such as when walking.

The nerve is almost certainly the medial plantar proper digital nerve – close to the big toe joint. Typically, this causes pain on one side of the big toe and is triggered by walking, especially in tight shoes.

In particular, given your description, I believe the probable cause is a specific form of entrapment neuropathy known as Joplin’s neuroma, which is characterised by pain, tingling or numbness near the first toe joint, when walking.

Compression of the nerve over time – perhaps as a result of wearing tight shoes or having a bunion – can lead to the formation of scar-like tissue, which can further irritate the nerve.

Ask your GP to refer you to an orthopaedic consultant specialising in foot disorders or an experienced podiatrist for a diagnosis.

Treatment will probably involve an injection of corticosteroid and an anaesthetic around the nerve to reduce any swelling.

While waiting for specialist treatment, you may be able to significantly improve your discomfort by wearing shoes with a wide tip across the toe area.

In my view... ignore fructose risk at our peril

Supermarkets are piled high with mountains of sugary drinks for the football World Cup.

Remarking on this to a friend, whose company makes aluminium cans, he told me he has more than 20 factories across the world and that in Saudi Arabia alone, for instance, they make more than 1.5 billion cans annually – testimony to how much sugar is being consumed.

No wonder we see so much obesity, type 2 diabetes and non-alcoholic fatty liver disease.

The latter affects 20 to 30 per cent of adults in the UK, but until the Millennium most doctors like me had almost never come across the condition.

The biggest offender is sugary drinks, specifically the fructose in them. This leads to fat building up in the liver and inflammation. In some patients eventually this causes liver cancer.

Studies suggest 200g of fructose (you get up to 18g in a 330ml can of cola) consumed daily for two weeks is enough to raise liver enzyme levels (a sign of liver inflammation).

We have strict recommendations and laws restricting alcohol intake – but apparently not a clue about the dangers of fructose. An astonishing thought.

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