Hyperacusis

What is hyperacusis?

Hyperacusis is a rare hearing disorder where sounds others perceive as normal seem uncomfortably — and often unbearably — loud. It’s also described as decreased sound tolerance, or DST. People with normal hearing experience a range of sounds with varying degrees of loudness. In contrast, people with hyperacusis experience sound in general with the volume turned too high.

Some examples of common sounds in everyday life that may feel intolerable to someone with hyperacusis include:

• People chatting.
• A car engine running.
• Water running in the kitchen sink.
• Household electrical appliances running.
• Someone turning the pages of a book or newspaper.
• Many other soft sounds.

The experience can take a toll on your mental health, causing you to feel irritable and anxious. Hyperacusis can impact your social life, too. Some people with hyperacusis avoid social situations to reduce the risk of experiencing intense loudness.

Hyperacusis often accompanies tinnitus, a condition often associated with hearing loss that involves ringing, whistling, clicking or roaring sounds in your ears. Still, not all cases of hyperacusis involve tinnitus or hearing loss.

How common is hyperacusis?

There’s still a lot that doctors don’t know about hyperacusis, including how common it is. Researchers estimate that 3.2% to 17.1% of children and adolescents have hyperacusis, while the range for adults is from 8% to 15.2%.

It’s hard to know for sure how common it is, though. People with hyperacusis describe their symptoms differently based on their unique experiences. Also, there isn’t a single, widely accepted way to screen for or measure hyperacusis. Researchers are still learning about hyperacusis, including how many people have it.

What are the symptoms of hyperacusis?

With hyperacusis, you may experience sounds other people consider normal as uncomfortable, unbearably loud, painful or even frightening. The loudness may be mildly annoying or so intense that it causes you to struggle with your balance or experience seizures.

Other symptoms may include:

• Ringing in your ears.
• Ear pain.
• A feeling of fullness or pressure in your ears (similar to being in an airplane, before your ears “pop”).

These symptoms can negatively impact your mental health and social life. The constant experience of feeling overwhelmed with intense, unpleasant sounds can lead to:

• Anxiety.
• Depression.
• Relationship issues.
• Social isolation and avoidance.

Symptoms may intensify if you feel stressed or tired or if you anticipate having to interact in spaces that you fear will be unpleasantly loud.

What causes hyperacusis?

Researchers are still trying to understand what causes hyperacusis. It’s likely that the structures in your brain that control how you perceive stimulation make sounds seem louder. With hyperacusis, your brain perceives sounds as loud regardless of their frequency — or whether the sound falls in the low range (like thunder rumbling), medium range (like human speech) or high range (like a siren or whistle).

Various theories exist. It’s possible that damage to parts of your auditory nerve causes hyperacusis. Your auditory nerve carries sound signals from your inner ear to your brain so you can hear. Another theory is that damage to the facial nerve causes hyperacusis. The facial nerve controls the stapedius muscle, which regulates sound intensity in your ear. Many conditions associated with hyperacusis (Bell’s palsy, Ramsay Hunt syndrome and Lyme disease) involve facial nerve damage.

Still, there isn’t a single cause that explains all cases of hyperacusis. Instead, it’s associated with multiple possible contributing factors and conditions.

Contributing factors include:

• Long-term exposure to loud noises: Hyperacusis is more common in people exposed to loud music for long periods, like rock musicians, or who work in loud settings, like construction workers.
• Sudden exposure to loud noise: Some people with hyperacusis develop it after hearing a sudden, loud noise, like a gunshot or fireworks.

Hyperacusis often accompanies conditions like tinnitus (up to 86% of people) and Williams syndrome (as many as 90% of people). Nearly half of the people diagnosed with hyperacusis also have a behavioral health condition, like anxiety.

Conditions associated with hyperacusis include:

• Anxiety.
• Autism.
• Bell’s palsy.
• Depression.
• Down syndrome.
• Ear infections (otitis media).
• Head injury.
• Lyme disease.
• Ménière’s disease.
• Migraines.
• Post-traumatic stress disorder (PTSD).
• Ramsay Hunt syndrome.
• Superior Canal Dehiscence Syndrome (SCDS).
• Temporomandibular joint syndrome (TMJ).
• Tinnitus.
• Williams syndrome.

Some people develop hyperacusis symptoms following surgery or as a reaction to a medication.

How is hyperacusis diagnosed?

Getting diagnosed can be difficult because not all healthcare providers are familiar with hyperacusis. You may need to see an ear, nose and throat specialist and/or an audiologist to help identify the problem.

Diagnosis may include:

• Medical history: A healthcare provider will consider any risk factors, like behavioral health issues (including anxiety or depression), exposure to loud sounds or damage to your hearing.
• Exam: They’ll look for structural issues in your ear that may relate to your hyperacusis. They may perform tests to see how your eardrum moves, like tympanometry. They may examine your cranial nerves to see if there are problems with how your facial nerve is functioning.
• Hearing tests: They’ll perform hearing tests to determine your hearing levels. They may also evaluate your loudness discomfort level, or LDL. The LDL shows at what levels you perceive noise as uncomfortably loud. The healthcare provider may also ask that you complete a questionnaire about your hearing to assess how severe your experience of hyperacusis is. These questions can show the extent that hyperacusis interferes with your everyday life.

Your healthcare provider may order imaging procedures if they suspect your hyperacusis results from a structural issue like facial nerve paralysis. They may also order lab work if they suspect that your hyperacusis relates to a condition like Lyme disease.

How is hyperacusis treated?

There isn’t a standard treatment for hyperacusis. Instead, treatments usually involve reducing physical symptoms and teaching coping strategies to handle the mental stress of hyperacusis. Treatments include:

• Sound therapy: The goal is to gradually (and safely) expose you to progressively louder sounds until the sound experience becomes more manageable. First, you hear sounds that are at a comfortable low-intensity level. Gradually, the volume increases so you get used to louder sounds over a few weeks.
• Cognitive behavioral therapy (CBT): CBT teaches how to deal with the stress and negative feelings associated with loud sounds. It reduces the fear and anxiety associated with hyperacusis. Studies have shown that CBT increases loudness discomfort levels (LDL) in people with hyperacusis.
• Tinnitus retraining therapy (TRT): TRT is usually a tinnitus treatment, but it can also treat hyperacusis. TRT includes educating people about their condition and providing counseling and sound therapy. With TRT, you listen to calming sound frequencies called “pink noise” through special headphones. Pink noise is similar to the sound of rain or wind. Pink noise creates a calming, predictable sound environment so that noises you might otherwise experience as jarring aren’t as unpleasant.
• Surgery: Your healthcare provider may perform a round and oval window reinforcement to address hyperacusis associated with facial nerve paralysis. The surgery uses tissue behind your ear to support the bones in your inner ear (ossicles) that help regulate sound intensity. This surgery improves LDL.

Can hyperacusis be cured?

There isn’t a cure for hyperacusis, but depending on what’s causing it, your symptoms may improve in time. For example, hyperacusis following surgery may go away once you heal from the procedure. People with Ménière’s disease may notice an improvement if the disease goes into remission.

What can I expect if I have this condition?

Healthcare providers and medical researchers are still studying the long-term effects of hyperacusis. For many people, hyperacusis is a long-term condition they learn to manage with treatment. Others experience symptom relief following surgery or once the underlying condition resolves.

When should I see my healthcare provider?

Many people with hyperacusis symptoms start by trying to drown out the sounds around them with earplugs or headphones. They may avoid social settings. But these options can make things worse. People who wear headphones or earplugs may experience sound even more intensely once they remove them, and social isolation can lead to (or worsen) behavioral health issues.

Don’t try to manage symptoms on your own. Instead, see a healthcare provider if you’re experiencing hyperacusis symptoms. It may take a while to identify what’s likely causing the issue, but there are therapies that can help.

Is hyperacusis a mental illness?

No, hyperacusis isn’t a mental illness. Hyperacusis is a hearing disorder commonly associated with mental health conditions, including anxiety and depression. Living with the excessive loudness characteristic of hyperacusis can affect your mental health. Anxiety about encountering sound and isolating yourself to spare your hearing can worsen hyperacusis symptoms.

A note from Cleveland Clinic

See a healthcare provider if you’re experiencing uncomfortably loud sounds. Trying to drown out the sound with noise-canceling headphones or earplugs may only worsen your symptoms in the long run. It may take some time to discover what’s likely causing your condition, but there are therapies that can help. Sound therapy and CBT have helped people with hyperacusis cope with their symptoms. If an underlying condition causes hyperacusis, seeking treatment can help.