Causes of hyperacusis

Overview

Hyperacusis is a condition where everyday sounds seem too loud, uncomfortable, or even painful. It is not the same as hearing loss – in fact, some people with hyperacusis have normal hearing. The brain processes sounds in an overly sensitive way.

Hyperacusis is not as common as tinnitus, but it affects about 1 in 50,000 people. It may be underreported because some people don't seek help.

Anyone can develop hyperacusis, but it is more common in people with tinnitus, head injury, or certain neurological conditions. It can occur at any age, including in children and older adults.

Symptoms

Common symptoms

• Everyday sounds like a vacuum cleaner, traffic, or a dishwasher seem too loud.
• Sounds that were once comfortable now cause discomfort or pain.
• Feeling anxious or stressed in noisy environments.
• Avoiding social situations or loud places because of sound sensitivity.

Symptoms in children

• Covering ears or crying when hearing certain sounds.
• Fussiness or irritability in noisy places.
• Trouble concentrating in a classroom because of background noise.

Symptoms in older adults

• Increased sensitivity to sounds that were previously fine.
• Difficulty enjoying social gatherings or family events.
• May also have age-related hearing loss, making sounds seem distorted.

Causes

Main causes

• Exposure to very loud noises (like a concert or gunshot) that damages the ear's hearing cells.
• Head injury or whiplash that affects the auditory pathway.
• Ear infections or Meniere's disease.
• Certain medications that are toxic to the ear (ototoxic drugs).
• Chronic tinnitus or migraine.
• Neurological conditions such as multiple sclerosis or autism spectrum disorder.

Risk factors

• Working in noisy environments without ear protection.
• Having tinnitus or other hearing disorders.
• History of head trauma or ear surgery.
• Taking high doses of aspirin or certain antibiotics (temporarily).
• Stress, anxiety, or post-traumatic stress disorder (PTSD).

When to see a doctor

See a doctor urgently if:

• If you experience sudden sound sensitivity after a head injury or loud noise exposure.
• If hyperacusis comes with sudden hearing loss, severe ear pain, or discharge.

Book a routine appointment if:

• If sound sensitivity lasts more than a few days and affects your daily life.
• If you are avoiding social situations or feeling anxious about sounds.

Diagnosis

A healthcare provider, such as a general practitioner (GP) or an ear, nose, and throat (ENT) specialist, will take a detailed history and examine your ears. They will ask about your symptoms, noise exposures, and any other conditions.

Tests that may be done

• Hearing test (audiogram) to check your hearing levels.
• Loudness discomfort levels (LDL) test to see at what volume sounds become uncomfortable.
• Sometimes a tympanometry test to check your middle ear function.

What to expect at your appointment

The tests are painless and usually take less than an hour. You will sit in a soundproof booth and respond to tones or sounds. The results help the doctor understand if hyperacusis is linked to hearing loss or other issues.

Treatment

Treatment focuses on retraining the brain to tolerate everyday sounds and addressing any underlying causes. It often involves a team approach with an audiologist, therapist, and doctor.

Self-care at home

• Use earplugs only in very loud situations – overuse can make sensitivity worse.
• Gradually expose yourself to sounds at a comfortable volume to build tolerance.
• Practice relaxation techniques like deep breathing to manage anxiety linked to sound.
• Avoid sudden loud noises – wear hearing protection when needed.

Medical treatments

Your doctor may refer you to an audiologist for sound therapy or tinnitus retraining therapy (TRT). Cognitive behavioural therapy (CBT) can help reduce the emotional impact. In some cases, medications for anxiety or depression may be prescribed, but always after a thorough discussion with your doctor. There are no drugs specifically approved for hyperacusis.

When is surgery considered?

Surgery is rarely needed. It may be considered if hyperacusis is caused by a structural problem like a perilymph fistula (a leak of inner ear fluid) or a tumour, but this is uncommon.

Living with this condition

Living with hyperacusis means finding a balance between protecting your ears and not avoiding sounds completely. Keep your home environment quiet but not silent. Use soft background music or white noise at a low volume to desensitise your hearing over time.

Lifestyle tips

• Let friends and family know about your condition so they can help reduce loud noises.
• Choose quieter venues for socialising, like cafés instead of bars.
• Carry earplugs or noise-cancelling headphones for unpredictable loud environments.

Diet and exercise

A healthy diet and regular exercise can help manage stress, which often makes hyperacusis worse. Some people find that reducing caffeine and alcohol helps, as these can increase sensitivity.

Mental health and emotional wellbeing

Hyperacusis can lead to anxiety, social isolation, and depression. It is important to talk to a mental health professional if you feel overwhelmed. You are not alone, and help is available.

Prevention

Not all cases can be prevented, but you can reduce your risk by protecting your ears from loud noises (use earplugs or earmuffs at concerts, in noisy workplaces, or when using power tools). Avoid inserting objects into your ear canal, and treat ear infections promptly.

Complications

If left untreated

• Increased anxiety and avoidance of social situations.
• Depression and withdrawal from relationships.
• Worsening sound sensitivity over time.
• Difficulty working or studying due to fear of noise.

Long-term outlook

With proper management, most people with hyperacusis improve. Treatments like sound therapy and counselling can help you regain control and live a full life. While some people may always be more sensitive than average, many learn to cope well.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.