Hyperacusis (sound sensitivity): symptoms, causes and treatment

What is hyperacusis?

Hyperacusis is when everyday sounds seem much louder to you than they should. It is also called sound sensitivity, noise sensitivity or decreased sound tolerance. Sounds that other people barely notice, like cutlery on a plate, a door closing or a busy street, can feel overwhelming or even painful. Often your hearing test comes back normal.

Symptoms

• Ordinary sounds feel too loud, sharp or intense.
• Discomfort or pain in or around the ear when there is sound.
• A feeling of fullness or pressure in the ears.
• Ringing or buzzing in the ears (tinnitus), which often comes with it.
• Avoiding places such as restaurants, parties or public transport because of the noise.

The four types

Clinicians often describe hyperacusis in four ways. Many people have more than one.

• Loudness: moderate sounds seem far louder than they do to others.
• Annoyance: sounds cause strong negative feelings. This overlaps with misophonia.
• Fear: you start to fear and avoid sound, sometimes called phonophobia.
• Pain: sounds cause physical pain in or around the ear.

What causes it?

There usually isn't one clear cause. Hyperacusis can start after a sudden loud noise or long exposure to loud sound. It is also linked to tinnitus, migraine, Ménière's disease, Bell's palsy, Lyme disease, autism and Williams syndrome, and to some medicines that can affect the ear.

How common is it?

In a Swedish population study, 9.2% of adults reported hyperacusis, while only 1.9% had been diagnosed by a doctor. Across population studies, estimates range from 0.2% to 17.2%, depending on how it is measured.

How is it diagnosed?

Start with your GP, who can refer you to a hearing specialist. An audiologist or ENT doctor may use questionnaires about your sound sensitivity, hearing tests that measure your loudness discomfort levels, and checks of the ear such as tympanometry. Sometimes other tests look for a related condition.

Treatment

The main approaches are sound therapy, which gets your hearing system used to sound again, and cognitive behavioural therapy (CBT), which works on the fear and avoidance that often come with it. Treating an underlying cause, such as migraine, can help too. Read more in our guide to hyperacusis treatment.

Ear pain? If sounds cause pain, speak to a doctor or audiologist before starting any sound therapy. Some specialists warn that sound exposure can make pain hyperacusis worse.

Can it get better?

There is no cure, but symptoms often improve, depending on the cause. Wearing earplugs all the time can make you more sensitive, so most specialists advise using protection only in genuinely loud places while you work on your tolerance.

When to see a doctor

See a GP if everyday noises feel too loud or painful. Get help sooner if you also have sudden hearing loss, dizziness, or pain that doesn't go away.