Online hyperacusis treatment: what it is and when it helps

Why specialist help can be hard to reach

In the NHS, the usual route is to see a GP, who may refer you to a hearing specialist for tests and treatment. That referral is where many people wait. The first step is often an audiology assessment, and NHS England publishes waiting figures for these every month.

These figures cover all hearing assessments, not hyperacusis alone. Treatment for sound sensitivity usually comes later and varies a lot by area. A 2025 survey of hearing professionals by the charity Tinnitus UK found that NHS clinicians reported waits of up to a year for psychology, talking therapy or CBT referrals, and up to three years for ENT appointments. That report is about tinnitus services, so it does not measure hyperacusis waits directly.

What online treatment can include

Online treatment is not a single thing. Programmes mix some or all of the following, and most mirror what a clinic would offer in person:

• Education about how hearing and the brain's sound filter work, and why avoiding sound can keep sensitivity high. See what is hyperacusis?
• Sound therapy guidance: choosing gentle background sound and raising it slowly. See sound therapy.
• CBT, either with a therapist over video or as guided self-help modules online. See CBT for hyperacusis.
• Advice on ear protection, so it is used for truly loud places rather than all day. See earplugs and hyperacusis.
• Regular check-ins and questionnaires to track progress and adjust the plan.

What the evidence says

The honest answer is that research on remote hyperacusis care is early. Most studies are small, many have no control group, and several look at tinnitus first and hyperacusis second. What exists is encouraging, though.

CBT by video call

A 2024 UK study looked back at 37 adults who had CBT with an audiologist over video calls for misophonia, hyperacusis, tinnitus or a mix. Scores on questionnaires, including a hyperacusis impact measure, improved after treatment. The authors call it a preliminary analysis and note there was no control group, so the results need caution.

Self-guided internet CBT

A 2022 study of an unguided internet CBT programme for tinnitus included 28 people, 12 of whom also had hyperacusis. Tinnitus management scores improved by a similar amount with or without hyperacusis, while the drop in anxiety and low mood was larger for those with tinnitus alone. Again, it was small and had no comparison group.

Larger internet CBT studies for tinnitus

Audiologist-guided internet CBT for tinnitus has been tested in randomised trials. In a one-year follow-up of two US trials, 132 of 200 invited participants replied. Benefits for tinnitus were maintained, and hyperacusis showed a small improvement. Hyperacusis was a secondary measure here, not the main target.

Programmes built for hyperacusis

Researchers in the United States have described HAT-Online, a four-week remote counselling programme adapted from their in-person hyperacusis activities treatment. It combines recorded videos, activities, handouts and live coaching sessions on topics such as reactions to sound, relaxation and gradual sound exposure. The 2025 paper sets out the programme and plans for trials; it does not yet report results.

In short: CBT for hyperacusis has support from an in-person randomised trial, and the early online studies point the same way. Larger, controlled trials of online treatment for hyperacusis are still needed.

What to look for in an online programme

• Qualified people. Audiologists, hearing therapists or psychologists with training in tinnitus and hyperacusis, and a way to find out who they are.
• An assessment first. Questions about your hearing, pain, triggers and medical history before any plan is set. Our guide to how hyperacusis is diagnosed covers what this usually includes.
• Personal sound levels. Gradual steps that start where you are, not a fixed playlist at a fixed volume.
• Clear safety advice. What to do if sounds cause pain, and when to stop and contact a doctor.
• Care with your data. Health information is special category data under UK data protection law and needs extra protection. Look for a clear privacy policy that says where your data is stored and who can see it.
• Honesty about evidence. Be wary of promises of a quick cure.

When to be seen in person first

Online care is a poor fit for symptoms that need a physical examination. The NHS advises:

• See a GP if everyday noises feel too loud or painful.
• 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 days or weeks, or hearing loss with earache or discharge.
• Ask for an urgent GP appointment if you have tinnitus that beats in time with your pulse.
• Go to A&E or call 999 if you have tinnitus after a head injury, or tinnitus with sudden hearing loss, weakness in the face or a spinning sensation (vertigo).

Once these have been checked, online treatment can sit alongside your NHS care or fill the gap while you wait. For the wider picture, see hyperacusis treatment, tinnitus and hyperacusis and living with hyperacusis.

About Attune

A note on our own work: Attune is building an online hyperacusis programme with education, sound therapy and specialist check-ins. It has not launched yet and has not been tested in a trial, so we make no claims about how well it works. If you would like to hear when it opens, you can read more and join the waitlist.