Credit:    woodleywonderworks   , Flickr

Credit: woodleywonderworks, Flickr

Richard S. Tyler, Ph.D., professor of communication sciences and disorders and of otolaryngology at the University of Iowa, describes four categories of hyperacusis: loudness, annoyance, fear, and pain. While he sees all of these subtypes intersecting in the clinic, epidemiological data on hyperacusis are lacking, “so it's hard to know how much overlap actually occurs,” he said.

  • Loudness hyperacusis: moderately intense sounds are perceived as too loud

  • Annoyance hyperacusis: a negative emotional reaction to sounds

  • Pain hyperacusis: a stabbing sensation at much lower sound levels than would typically prompt pain. This is sometimes described as a sharp or dull pain in the ear, jaw, or neck, feeling of fullness in the ear, or a tingling in the ear according to Lindsey Banks, Au.D.

  • Fear hyperacusis: a negative response to sounds that may cause patients to avoid social situations or feel anxiety in anticipation of hearing these sounds

Dr. Tyler explains that one type of hyperacusis may lead to another. “If you experience loudness hyperacusis, emotional consequences may follow, leading to stress and annoyance, which eventually lead to fear of going to events and socializing,” he said. “Pain is a little more complicated because it consists of both a fundamental attribute and an emotional consequence.”

Source: The Hearing Journal; Everyday Hearing



Presently, there are no specific surgical or medical treatments for hyperacusis. However, a number of techniques exist to help individuals better manage hyperacusis. Many of them mirror the treatments used for tinnitus.

Sound Therapy is used to retrain the brain to accept everyday sounds. This involves the use of a noise-generating device worn on the affected ear or ears for at least two hours a day. To ensure comfort for the patient, the device produces a gentle static-like sound (white noise or broadband noise) that is barely audible. Completion of sound therapy may take up to 12 months and usually improves sound tolerance. Sound therapy may additionally include carefully prescribed introduction of the specific environmental sound that is bothersome instead of using broadband noise. Introduction of sound usually begins below the person’s tolerable sound level and is then gradually increased over time.

Cognitive Behavioral Therapy (CBT) is used for hyperacusis in addition to depression, anxiety, post-traumatic stress disorder, and other conditions. It focuses on restructuring the negative reactions and regaining control over the condition. Adopted from tinnitus treatment, CBT for hyperacusis involves education, relaxation training, specifically prescribed exposure to sounds, and cognitive therapy to reduce stress and beliefs associated with hearing certain sounds.

With Hyperacusis Activities Treatment, the patient’s goal is to be able to recognize the relationship between the loudness of a sound and his or her reaction to it. The counseling components include: thoughts and emotions, hearing and communication, sleep, and concentration.

Hearing Protection can be worn to mitigate the discomfort of hyperacusis. There are many types including foam earplugs, silicone or putty types, custom earplugs that are shaped to fit the ear, and over-the-head ear muffs. 

Sources: American Academy of Otolaryngology–Head and Neck SurgeryEveryday Hearing; Hyperacusis Network; Hyperacusis Focus 



Thanks to the generosity of Hyperacusis Research, Hearing Health Foundation (HHF) funds groundbreaking research to advance our scientific understanding of hyperacusis and loudness intolerance.

Grants focused on hyperacusis are awarded annually to promising scientific investigators through the Emerging Research Grants (ERG) program.



Kelly Radziwon, Ph.D., and Senthilvelan Manohar, Ph.D., measured noise-induced changes in the expression (amount) of genes involved in the synthesis of proteins known to be involved in neuropathic pain and neuro-inflammation. Interestingly, the researchers found that intense noise exposure significantly altered the expression of six genes (Ccl12, Tlr2, Oprd1, II1b, Ntrk1 & Kcnq3) in the cochlear nucleus. These results suggest that noise-induced inflammation in the parts of the central auditory pathway that also processes sensory information related to pain might, in turn, activate the central pain pathway thus producing ear pain. Learn more.

Kelly Radziwon, Ph.D., and Senthilvelan Manohar, Ph.D., observed that stress may interact with hearing loss in tinnitus and hyperacusis development. Exploring two novel non-auditory areas implicated in these conditions, they conclude increased stress response has the potential to have wide-ranging effects on the central nervous system and may therefore contribute to brain-wide changes in neural activity. Learn more.

Xiying Guan, Ph.D, and colleagues assessed an existing treatment for hyperacusis and discovered its negative effects. They tested how inner ear round window (RW) reinforcement affects air-conduction sound transmission in the typical ear. The results suggest that RW reinforcement has the potential to worsen low-frequency hyperacusis while causing some hearing loss in the mid-frequencies. Learn more.

Senthilvelan Manohar, Ph.D., and colleagues have compiled evidence supporting that startle reflex amplitudes may be related to hyperacusis in the elderly. The experiments were conducted using a mouse model for early age-related hearing loss. Learn more.

Kelly Radziwon, Ph.D., and colleague created an animal model of hyperacusis that provides the necessary groundwork for future studies of noise-induced hyperacusis and loudness intolerance. Learn more.