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.”