Your Guide to Hyperacusis

Medically Reviewed By Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP
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Hyperacusis is a condition affecting sensitivity to sound. An individual with hyperacusis experiences pain and discomfort when exposed to everyday noise. This usually occurs following damage to the ear or as a result of a neurological condition. Hyperacusis is sometimes called sensitive hearing, and it affects around 1 in 50,000 people. While hyperacusis typically occurs as a result of exposure to loud noises, it can also affect people with tinnitus or neurological conditions.

Read on to find out more about what causes hyperacusis, as well as what treatment options may be available.

What is hyperacusis?

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Hyperacusis is a disorder in which the brain struggles to process noise, making many everyday sounds become painful and unbearable. This sensitivity to sound usually develops later in life as a result of trauma or exposure to loud noises, but it can also occur as a result of a neurological condition.

The condition can affect both adults and children, and it may be present in either one or both ears. If left untreated, hyperacusis can result in social isolation and difficulty taking part in everyday events.

One type of hyperacusis is cochlear hyperacusis, which refers to ear pain and discomfort as a result of hearing certain sounds. Vestibular hyperacusis is not as widely recognized as cochlear hyperacusis. This occurs when exposure to noise results in falling or a loss of balance or postural control.

The main types of cochlear hyperacusis are:

  • Pain hyperacusis: You experience pain with noises that are typically not too loud.
  • Loudness hyperacusis: Moderately loud sounds are very loud and painful.
  • Annoyance hyperacusis: You have a negative emotional reaction when hearing noise.
  • Fear hyperacusis: You anticipate and avoid loud noises.

Is hyperacusis a mental illness?

Hyperacusis is a hearing disorder. While the condition is not a mental illness, studies suggest that there may be links between psychiatric disorders and sensitivity to sound. For example, in a 2020 study, up to 56% of people with hyperacusis also had at least one current psychiatric disorder, with 47% of those people experiencing anxiety.

A 2019 study also notes links between sensitive hearing and mental illness, suggesting that clinicians treating patients for hyperacusis or tinnitus should also screen them for signs of self-harming or risks of suicide.

While hyperacusis is a hearing disorder that typically occurs following exposure to loud noise or as a result of trauma, individuals with certain mental illnesses may be at a greater risk of developing hyperacusis.

What causes hyperacusis?

A person with hyperacusis is not typically born with the condition. It usually develops following physical trauma, after exposure to loud noises, or as a result of a neurological condition. Causes of hyperacusis include the following:

Hyperacusis can affect any person at any age. However, a 2021 study explains that certain groups of people are more at risk of developing hyperacusis than others. These include:

Signs and symptoms of hyperacusis

Signs and symptoms of hyperacusis may appear suddenly, or they may develop more gradually over time. Signs that you may be experiencing hyperacusis include the following:

  • feeling uncomfortable around certain sounds
  • covering your ears to try to block out noise
  • feeling angry, anxious, or distressed around everyday sounds
  • experiencing pain or discomfort

If you are experiencing any of these symptoms, contact your doctor to arrange an ear examination.

Hyperacusis and tinnitus

Many people who experience hyperacusis also experience tinnitus. Around 86% of people with hyperacusis also have tinnitus, while 30–40% of individuals with tinnitus experience symptoms of hyperacusis.

Tinnitus is described as a ringing, buzzing, or hissing sound in the ear that is not due to any external source of noise. You may experience tinnitus constantly or only now and again.

If you think you might be experiencing tinnitus alongside hyperacusis, contact your doctor to find out more about assessment and treatment options for both conditions.

Other conditions affecting tolerance to sound

A number of conditions affecting the ears share similar symptoms. Examples of conditions causing hearing sensitivity similar to hyperacusis include:

  • Misophonia: With misophonia, exposure to certain everyday sounds makes you feel angry.
  • Phonophobia: With phonophobia, some types of noise can make you feel anxious.
  • Recruitment: This occurs if you have difficulty adjusting between quiet and loud sounds.

Head to our hub on ear health for more information about conditions affecting hearing and the ears.

Hyperacusis in children

Hyperacusis can occur at any age. A 2020 study about children and hyperacusis notes that children as young as 3 or 4 years old experience hyperacusis, which could be a typical and perfectly healthy feature of development in the child.

Hyperacusis can occur alongside other conditions such as autism and ADHD, with symptoms including crying, aggressive behavior, and covering the ears.

Advice for helping a child with signs of hyperacusis includes the following:

  • Explain the source of the sound to the child.
  • Try to create a game out of the noise by tapping or shaking objects, making sure the child is in control of the game.
  • Avoid providing the child with earplugs, as it can make the ears more sensitive over time.
  • Attempt to repeatedly and gently expose the child to the sound so that it may become less distressing.
  • Do not force the child to stay around the sound if it is causing them distress.
  • Help your child to stay as relaxed as possible, such as with controlled breathing and muscle-relaxing exercises.

What triggers hyperacusis?

Hyperacusis occurs when everyday noise feels loud and painful. This includes a wide range of sounds, such as:

  • barking dogs
  • bus brakes
  • car engines
  • the sound of somebody chewing
  • vacuum cleaners

Certain environments and social spaces can also trigger hyperacusis. Examples of places and situations that people with hyperacusis may avoid include:

  • shopping centers
  • theaters
  • restaurants
  • cars and motor vehicles
  • music concerts

Treatments for hyperacusis

It is possible to treat hyperacusis in order to reduce the sensitivity to sounds and to learn behaviors that can help to manage reactions to loud noise. The two main types of hyperacusis treatment include:

  • Sound therapy: This helps you get used to everyday sounds and reintroduces sounds. It may include wearing an earpiece that produces white noise.
  • Cognitive behavioral therapy (CBT): CBT can help you manage social situations and control any anxiety that occurs as a result of hyperacusis.

Can I wear earplugs for hyperacusis?

It is best to avoid wearing earplugs or earmuffs to block out loud noise. While they may provide a short-term solution, once you remove the earplugs, the sounds may seem louder than before.

When possible, do not avoid noisy situations. Spending a lot of time away from noise means that any loud sounds you do encounter may be more painful or uncomfortable. Try to slowly reintroduce noisy situations back into your life with the help of sound therapy or CBT.

Diagnosing hyperacusis

To diagnose hyperacusis, your doctor will refer you to an audiologist, who will then conduct a thorough examination. This includes a hearing test that determines how well you can hear sounds at different frequencies.

The audiologist will ask you questions about your experience with sensitive hearing. Examples of questions they may ask include:

  • Are there are any issues with hearing in your own medical history?
  • How long have you have had sensitive hearing?
  • How severe is the pain and discomfort around loud noises?

Further tests may be required before the audiologist can diagnose you with hyperacusis. Following diagnosis, you may be offered sound or behavioral therapies.

Summary

Hyperacusis is a hearing sensitivity disorder in which the individual feels pain and discomfort from everyday sounds. The condition typically occurs following exposure to loud noise or as a result of a neurological condition.

Hyperacusis can occur suddenly or gradually over time, and it can affect either one or both ears. People of any age may experience hyperacusis.

Treatments for hyperacusis include sound therapy and CBT. These can help improve the quality of life for individuals with hyperacusis by providing techniques for managing the condition and relieving anxiety associated with loud noises.

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Medical Reviewer: Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP
Last Review Date: 2022 Feb 25
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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