How hyperacusis is diagnosed (and is there a test?)

Is there a test for hyperacusis?

Not one that gives a simple yes or no. Hyperacusis is about how sound feels to you, and many people with it have normal results on a standard hearing test. So specialists put together several pieces: your own description, how your ears respond to sound in the clinic, and how much the problem affects your daily life. If you are new to the condition, our guide to what hyperacusis is is a good place to start.

Step one: seeing your GP

The NHS advises seeing a GP if everyday noises feel too loud or painful. Your GP can look in your ears, ask about your symptoms and general health, and may refer you to a hearing specialist, usually an audiologist, for further tests and treatment. Sometimes an ear, nose and throat (ENT) doctor is involved too.

What an audiologist does

An appointment usually starts with questions: which sounds bother you, whether they feel too loud, frightening or painful, how long this has been going on, and how it affects work, sleep and time with others. ASHA, the American professional body for audiologists, lists this history and its impact on your life as a core part of the assessment. Then come some tests.

Loudness discomfort testing is the one most closely tied to hyperacusis. ASHA notes that results can change over time, because hyperacusis itself can fluctuate, so the test may be repeated. It also notes that some people cannot tolerate standard hearing tests. You are always in control: tell the audiologist if anything feels too much, and it can stop.

Cleveland Clinic adds that, depending on your symptoms, a doctor may order imaging or blood tests to look for related conditions.

Questionnaires

Because hyperacusis is so personal, questionnaires are an important part of the picture. Common ones include:

• The Hyperacusis Questionnaire (Khalfa). Fourteen statements about everyday situations, each scored from 0 to 3, for a total out of 42. Its authors found the items fall into three areas: attention, social life and emotions. In their original study, a score above 28 seemed to reflect strong sound sensitivity, though later studies have used other cut-offs, such as above 22.
• The Hyperacusis Impact Questionnaire and Sound Sensitivity Symptoms Questionnaire. Two short forms, of eight and five items, developed at a UK tinnitus and hyperacusis clinic to measure how much sound intolerance affects you and what kind of symptoms you have.
• The Inventory of Hyperacusis Symptoms. A longer, 25-item questionnaire that looks at several sides of the condition.

Specialists often repeat the same questionnaire during treatment, so you can both see whether things are improving.

Why online self-checks are not a diagnosis

Online quizzes can help you put words to what you are feeling, and that is useful. But they cannot look at your eardrum, measure your hearing or rule out other causes of your symptoms. Scores also mean most in the hands of someone who knows how the questionnaire was designed. Treat any result as a reason to book an appointment, not as an answer.

How to prepare for your appointment

• A short diary of the sounds that bother you, where you were, and how you felt afterwards.
• When it started, and anything that happened around then, such as an illness, injury or very loud event.
• Other symptoms, such as tinnitus, ear pain or pressure, or dizziness.
• A list of your medicines and any health conditions.
• How you currently protect your ears. If you use earplugs a lot, say so.
• Your questions, written down, so nothing is forgotten if the clinic feels overwhelming.

It is fine to ask for a quieter waiting area, or to bring ear protection for the journey.

When to get help quickly. The NHS says to ask for an urgent GP appointment or contact NHS 111 if you have sudden hearing loss in one or both ears, hearing that has got worse over a few days or weeks, or hearing loss with earache or discharge. These can need prompt treatment, so do not wait for a routine appointment.

After the diagnosis

A diagnosis is the start of a plan, not a label to live with. Most treatment combines education, sound therapy and, for many people, cognitive behavioural therapy. Read more in our guide to hyperacusis treatment, or, if certain sounds make you angry rather than uncomfortable, see hyperacusis vs misophonia.