Hyperacusis: Sensitivity to Sound, Causes and Treatment

01Symptoms

Symptoms

• Everyday sounds feel too loud, sharp or overwhelming.
• Discomfort or pain in the ears with certain sounds.
• Anxiety or dread about noisy places.
• Avoiding restaurants, shops, public transport or social events.
• Using earplugs or headphones much of the time.
• Tiredness and irritability after being in noisy environments.
• Often tinnitus or a feeling of ear fullness at the same time.

02Types

Types of hyperacusis

• Loudness hyperacusis: moderate sounds are perceived as very loud.
• Annoyance hyperacusis: sounds cause strong irritation.
• Fear hyperacusis: fear and avoidance of sounds (sometimes called phonophobia).
• Pain hyperacusis: sounds cause physical pain in or around the ear.
• A review of hyperacusis proposed these categories to help describe and research the condition.

03Causes

Causes and associated conditions

• Exposure to loud noise, such as concerts, gunfire or machinery.
• Tinnitus and noise-induced hearing loss.
• Head injury or whiplash.
• Migraine.
• Ear conditions, including Ménière’s disease and ear infections.
• Bell’s palsy, affecting the small muscle that dampens sound.
• Autism and some neurological conditions.
• Stress, anxiety and post-traumatic stress disorder.

04Why

Why it happens

Researchers believe hyperacusis involves increased “gain” in the brain’s auditory pathways: after damage or reduced input, the brain turns up its sensitivity to sound, so ordinary sounds feel too loud. Emotional and stress-related brain systems can also amplify the reaction. Protecting the ears from all sound can make the brain even more sensitive, which is why treatment usually involves carefully increasing sound exposure.

05Misophonia

Hyperacusis or misophonia?

In misophonia, specific trigger sounds, often made by other people, such as chewing, breathing or tapping, cause intense anger, disgust or distress, regardless of how loud they are. Hyperacusis is more about the loudness of many everyday sounds. The two can occur together. Both can be helped by audiologists and psychological therapies.

06Treatment

Treatment

• Assessment by an audiologist or ENT specialist, including a hearing test.
• Education and counselling about how hyperacusis works.
• Sound therapy: low-level background sound, such as wearable sound generators or sound apps, to gradually desensitise the auditory system.
• Gradual exposure to everyday sounds in a planned way.
• Cognitive behavioural therapy to reduce fear and avoidance.
• Tinnitus retraining therapy approaches for people with both tinnitus and hyperacusis.
• Treatment of underlying conditions such as migraine.

07Evidence

What the evidence shows

A randomised controlled trial of cognitive behaviour therapy for hyperacusis found that participants who received CBT had greater improvements in sound tolerance, measured by loudness discomfort levels, and reductions in fear and avoidance than those on a waiting list. Sound therapy and tinnitus retraining approaches are widely used, though larger trials are needed. The NHS notes that treatment often involves retraining your brain to tolerate everyday sounds.

08Earplugs

Should you wear earplugs?

Earplugs are appropriate in genuinely loud environments, such as concerts or power tools, to prevent hearing damage. But wearing them all the time, or in quiet everyday situations, can make hyperacusis worse by reducing sound input and increasing the brain’s sensitivity. Audiologists usually recommend gradually reducing earplug use in everyday settings while protecting against truly loud sounds.

09Self

Self-help strategies

• Avoid complete silence; use low-level background sound at home.
• Gradually spend time in mildly noisy places, increasing slowly.
• Practise relaxation and slow breathing to reduce the stress response.
• Keep a diary of situations and reactions to track progress.
• Protect your ears from truly loud noise.
• Look after sleep and general health.
• If you also have tinnitus, see tinnitus treatment.

10Related

Hyperacusis with other ear symptoms

Hyperacusis often occurs with tinnitus, a sense of fullness or mild hearing loss. Episodes of sensitivity with vertigo, ear fullness and fluctuating hearing may suggest Ménière’s disease; see Ménière’s disease. High-pitched ringing after noise exposure is a warning sign to protect your ears; see high-pitched ringing in the ears.

11Daily

Living with hyperacusis day to day

• Explain the condition to family, friends and colleagues so they understand your needs.
• Plan outings at quieter times while gradually building tolerance.
• Choose seats away from speakers or kitchens in restaurants.
• Take short breaks from noisy environments rather than avoiding them entirely.
• Ask your employer about reasonable adjustments, such as a quieter workspace.
• Notice progress, such as tolerating a busy shop for longer than before.

12Children

Hyperacusis in children

Some children, particularly autistic children, are very sensitive to sounds such as hand dryers, vacuum cleaners or school bells. Predictable routines, warnings before noisy events, a quiet space to retreat to and gradual, positive exposure can help. Ear defenders can be useful for very loud situations but should not be worn all the time. An audiologist or occupational therapist can advise.

13Summary

Key points to remember

• Hyperacusis is reduced tolerance to everyday sounds.
• It often occurs with tinnitus and after noise exposure.
• Overusing earplugs can make it worse.
• Sound therapy, gradual exposure and CBT help.