Hyperacusis

Hyperacusis is a rare hearing disorder where sounds others perceive as normal seem uncomfortably — and often unbearably — loud. It’s also called decreased sound tolerance, or DST.

People with typical hearing experience a range of sounds with varying degrees of loudness. But 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 this condition 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. It can make you feel irritable and anxious. This condition can impact your social life, too. Some people avoid social situations to reduce the risk of experiencing intense loudness.

Hyperacusis often accompanies tinnitus, a more common condition related to hearing loss that involves ringing, whistling, clicking or roaring sounds in your ears. Still, not all cases involve tinnitus or hearing loss.

Symptoms of hyperacusis

This condition may cause you to experience regular sounds as uncomfortable, unbearably loud, painful or even frightening. The loudness may be mildly annoying. Or it may be so intense that it makes you struggle with your balance or even have seizures.

Other symptoms may include:

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

Symptoms may get worse if you’re stressed or tired. Even worrying about noise exposure may make things worse.

Hyperacusis causes

There isn’t a single cause that explains why it happens. But lots of theories exist.

It’s possible that auditory nerve damage 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 your facial nerve causes it. Your facial nerve controls a muscle inside your ear that regulates loudness.

Experts have found that it’s linked to many conditions. It’s especially common in people with Williams syndrome and tinnitus. Nearly half of people with hyperacusis also have a behavioral health condition, like anxiety or depression.

Other conditions associated with it include:

• Autism
• Bell’s palsy
• Down syndrome
• Ear infections
• Lyme disease
• Ménière’s disease
• Migraines
• Ramsay Hunt syndrome
• Superior canal dehiscence syndrome
• Temporomandibular joint syndrome

Risk factors

Factors that increase your risk include:

• Long-term exposure to loud noises: You’re at an increased risk if you’re exposed to loud sounds for long periods, like if you’re a musician or construction worker.
• Sudden exposure to a loud noise: You may develop it after hearing a sudden, loud noise, like a gunshot or fireworks.
• Ototoxic medicines: You may develop extreme noise sensitivity after taking medicine that’s “ototoxic.” This means the meds may cause hearing or balance damage as a side effect.
• Trauma: Damage to hearing structures during surgery or because of a head injury can increase your risk.

Complications of this condition

The symptoms of hyperacusis can 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

How doctors diagnose this condition

You may need to see a specialist for this diagnosis, like an otolaryngologist (ENT), neurotologist or audiologist. They’ll consider your medical history and do an exam to check for structural issues in your ear.

Diagnosis may involve:

• Questionnaires: You may complete a questionnaire about how sensitive you are to various noises and how that impacts your life.
• Hearing tests: In addition to a general hearing test, your provider may check your loudness discomfort level (LDL). This shows what noise level your brain perceives as uncomfortably loud.
• Tests that check your ears: You may need tests that check the parts of your ear for damage. For instance, you may need tympanometry to see how your eardrum is working.
• Imaging tests: Imaging can help diagnose conditions that often happen with hyperacusis, like facial nerve damage.
• Lab tests: Some signs of conditions related to hyperacusis, like Lyme disease, may show up in blood work.

How is it treated?

There isn’t a standard treatment for hyperacusis. Instead, your healthcare provider will suggest therapies that reduce symptoms. They’ll teach you coping strategies to manage it. Treatments include:

• Sound therapy: This treatment gradually (and safely) exposes you to louder sounds. First, you hear sounds at a comfortable low-intensity level. The volume increases so you get used to louder sounds over time.
• Cognitive behavioral therapy (CBT): CBT teaches how to deal with the negative feelings associated with loud sounds. Research shows that CBT improves loudness discomfort levels (LDL) in adults with hyperacusis.
• Tinnitus retraining therapy (TRT): With TRT, you listen to calming “pink noise” through headphones. Pink noise is like the sound of rain or wind. It creates a calming sound environment so that noises that might otherwise be jarring aren’t as unpleasant.
• Surgery: If you have hyperacusis due to facial nerve paralysis, surgery may help. A surgeon uses tissue behind your ear to support the inner ear bones that manage sound intensity.

Can hyperacusis be cured?

There isn’t a cure. But depending on the cause, your symptoms may improve in time.

For instance, hyperacusis after surgery may go away once you heal from the procedure. Switching medicines may help if noise sensitivity is a medication side effect. People with Ménière’s disease may notice an improvement if the disease goes into remission.

When should I see my healthcare provider?

See a healthcare provider if everyday noises sound unbearably loud or painful. It may take a while to find what’s causing the issue. But there are therapies that can help.

How long does it take for hyperacusis to heal?

Medical experts are still studying the long-term effects of hyperacusis. Some people have symptom relief once they get treatment for the condition causing it. But for many people, it’s a long-term condition they learn to manage with treatment.

Even when symptoms don’t go away for good, therapies can improve things. For instance, research shows that sound therapy often increases sound tolerance within six months to a year.

Is there anything I can do to feel better?

The best thing you can do is see a healthcare provider instead of trying to manage the condition on your own. This is because with hyperacusis, the obvious solutions can make things worse.

For example, you may want to drown out sounds with noise-canceling earplugs or headphones. You may avoid social settings. But wearing headphones or earplugs can make sounds even more intense once you remove them. Social isolation can lead to (or worsen) anxiety and depression.

You have the best chance of finding relief by working with a healthcare provider who has experience in treating this condition.

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 the likely cause, but there are therapies that can help.

What are the 4 types of hyperacusis?

Some healthcare providers find it helpful to think of this condition as one of four types. The groupings describe it based on the symptom that seems to bother a person the most. They are:

• Loudness hyperacusis: You hear sounds that are at a normal volume as uncomfortably loud.
• Annoyance hyperacusis: You have intense negative feelings about certain noises. It’s also called misophonia.
• Fear hyperacusis: Also called phonophobia, the negative feelings are so intense that you’re afraid of how you’ll experience sounds.
• Pain hyperacusis: Your extreme sensitivity to sounds makes your ears and head hurt.

Experts disagree, though, on whether these are different types of the same condition. It’s possible that people with hyperacusis just experience things like negative emotions or physical pain on a spectrum. Some experts see misophonia and phonophobia as entirely different conditions from hyperacusis.

Regardless of the labels, the important thing to know is that hyperacusis is a real condition that can impact your quality of life. No matter your experience, there are therapies that can help.