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What is Hyperacusis?

Hyperacusis is a disorder in loudness perception. Patients suffering from hyperacusis may appear overly sensitive to a range of sounds, finding many noises unbearable and painfully loud. Hyperacusis is not the same as "recruitment," a disorder that can be a normal consequence of hearing loss and is associated with abnormal perception of sound as the volume increases.

The hallmark symptom of hyperacusis is having a reduced tolerance and increased sensitivity to everyday sounds in your normal environment. People who suffer from the disease often complain of living in a world in which the volume seems to be turned up too high. Because of this, their quality of life is affected, and they may begin to wear earplugs or earmuffs in public situations where they cannot control the noise.

For people with hyperacusis, the everyday, normal sounds that most people hardly notice suddenly become irritating and painful. Often the most disturbing sounds are sudden, high-pitched noises, such as alarms, bus brakes, the clanging of silverware and dishes, children's screams and clapping.

Types of Hyperacusis

The two most common types are:

  • Cochlea Hyperacusis – damage to the sound sensing organ (cochlea) that results in the brain having sound sensitivities around certain pitches; and
  • Vestibular Hyperacusis – a form of Hyperacusis that also affects a person’s Vestibular (balance) system resulting in nausea, dizziness and the sensation of falling, in addition to sound hypersensitivity and/or Tinnitus and hearing loss.


Pre-existing tinnitus, Misophonia and High levels of anxiety are factors that can predispose towards the development of hyperacusis. Some of the other Common causes include:

  • Head injury 
  • Ear damage from toxins or medication
  • Fibromyalgia
  • Lyme disease
  • Air bag deployment( acoustic Shock)
  • Viral infections involving the inner ear or facial nerve (Bell’s palsy)
  • Temporomandibular joint (TMJ) syndrome
  • Autistic Spectrum disorders
  • Meniere’s disease
  • Otosclerosis
  • History of childhood middle ear infections
  • Vestibular migraines.

There are also a variety of neurologic conditions that may be associated with hyperacusis, including:

  • Post-traumatic stress disorder
  • Chronic fatigue syndrome
  • Tay-Sach's disease
  • Some forms of epilepsy
  • Valium dependence
  • Depression
  • Migraine headaches

How is hyperacusis diagnosed?

The audiological test battery used at our clinic consists of the following tests.

  • Our audiologist will begin by conducting a thorough physical examination and asking you about medical history, including questions about the length and severity of symptoms.
  • Pure tone audiometry and speech audiometry.
  • Measuring Uncomfortable loudness levels for both the ears at all the frequencies.
  • Tympanometry and Acoustic reflexes (Certain types of hyperacusis may have abnormal acoustic reflexes.)
  • OtoAcoustic Emissions
  • Auditory brainstem response(for brainstem lesions)

After the assessment is completed your results would be discussed with you. Audiologist will give you an opinion about the type of your hyperacusis. In order to rule out any potential medical cause of your symptoms you might be referred to be evaluated by a physician expert in ear disease, usually an otologist, neurologist, or otoneurologist.


There’s little value in assessing a problem if the assessment doesn’t lead to some form of treatment. In the past, patients with decreased sound tolerance rarely received evidence-based or adequate care for their problem. The management plan for patients with decreased sound tolerance is based directly on information from the history, inventories, questionnaires, and audiologic testing. Often a multi-disciplinary management strategy is needed.

  • A patient with a history suggesting possible central nervous system disorder like migraine or depression is referred to a neurologist or a psychiatrist.
  • A child with sensory disturbances in addition to hyperacusis, including intolerance to light and tactile stimulation, is referred to an occupational therapist for evaluation of possible sensory integration disorder.
  • Patients taking medications that are associated with hyperacusis need to consult with their family physician or the physician prescribing the drugs.
  • And some patients with hyperacusis benefit from consultation with a psychologist who has expertise in cognitive behavioural therapy.

For most hyperacusis patients we begin the management process with intensive counselling and recommendations for sound enrichment. Audiologic test results almost always confirm that the patient’s hearing sensitivity is entirely normal. Most patients with hyperacusis are worried about loud sounds damaging their hearing. Therefore, Counselling is essential for any patient with decreased sound tolerance. And, it’s directed to the specific problems the patient is experiencing.

Counselling inevitably includes a recommendation for sound enrichment. In response to their discomfort with loud sounds, patients with hyperacusis tend to reduce their exposure to environmental sound stimulation. Some patients even regularly use earplugs or earmuffs to “protect” their ears from loud sounds. Unfortunately, these well-intentioned strategies further decrease tolerance to sound. Patients are strongly encouraged to surround themselves with soft and relaxing sound, and to progressively increase their exposure to typical everyday sounds.

Patients are regularly followed either with clinic visits or at least email communication to monitor progress.  A small proportion of patients with debilitating hyperacusis might show inadequate progress. We then recommend consultation with a psychologist, and preferably one with expertise in cognitive behavioural therapy

What to do if you have hyperacusis?

  1. Avoid exposure to extremely loud noises and sounds. Don't overdo it however, as keeping things very quiet may increase your sensitivity.
  2. Avoid stimulants such as caffeine, chocolate and nicotine. We also suggest avoiding ADD drugs such as amphetamines, Provigil, and medications that increase vigilance. 
  3. Avoid migraine triggers -- MSG, alcohol, aged cheese, chocolate (in other words, follow migraine diet).
  4. Exercise daily, get adequate rest, and avoid fatigue.
  5. Avoid ototoxic medications that might damage your ears such as aspirin, non-steroidals and quinine containing preparations.