I have hearing loss. Why do loud sounds startle me?

A common question we get from readers goes something like this:

Even though I can't hear well I sometimes get really bothered by louder sounds. They are more irritating and even painful than they used to be. What's going on?

As odd as this sounds, it's not unusual. Hearing specialists even have a term for this phenomenon, known as auditory recruitment. It's also sometimes called auditory distortion.

Why some sounds sounds extremely loud: Auditory recruitment

When the fragile hair cells in our inner ears start to degrade, as they do with age-related hearing loss and other types of sensorineural hearing loss, they can no longer react to sound waves normally. This is what causes hearing loss.

However, our cells don't degrade evenly—some hair cells remain perfectly functional and can still detect sound waves. Once the volume gets loud enough, it's these healthy cells that get suddenly "recruited" in place of the dying cells and respond quickly and forcefully. This can result in sound actually feeling startling and uncomfortable!

A common experience: A person with hearing loss doesn't respond to someone trying to get their attention while speaking at normal or low levels. As the person speaks louder and louder in an attempt to get their attention, the person with hearing loss suddenly hears them and reacts forcefully as if they are in pain, perhaps covering their ears or responding with "stop shouting!"

Hyperacusis is similar but not the same

A similar phenomenon is hyperacusis, or a heightened sensitivity to sound. However, unlike recruitment, hyperacusis is usually perceived as painful, and is not connected to hearing loss. Children with autism and auditory processing disorder may be very sensitive to certain sounds, for example. Adults also can have auditory processing disorder.

Treating hearing loss and recruitment

Recruitment isn't something you have to suffer with—it's treatable. However, only a qualified hearing care provider can diagnose what exactly is causing a person to be overly sensitive to sounds, via specialized testing. 

If you have hearing loss with recruitment, a high-quality pair of hearing aids can be set to compress sounds in the specific range that tends to bother you. Lower-end models and hearing amplifiers are unlikely to be of much help since they don't have as many compression bands that can be adjusted, resulting in poor hearing overall. 

The key is to have a skilled hearing care provider who knows how to recognize recruitment and program your hearing aids appropriately.

Keep in mind that recruitment is something that can develop over time—you may start to notice unusual sound sensitivity even after you wear hearing aids, for example. In that case, it's important to let your hearing care provider (an audiologist or hearing instrument specialist) know that you find some sounds really painful, compared to years past. Some people find relief with tinnitus retraining therapy. 

If you need a provider

If you're really struggling with recruitment, it's best to seek out an audiologist who specializes in complex cases. In some cases, people struggle with recruitment in the same volume range as speech sounds, a situation that needs expert care. 

If you've been living with hearing loss and sound sensitivity for years, don't wait any longer: Untreated hearing loss increases your risk of social isolation and is linked to depression and cognitive decline. Hearing aids can restore your quality of life in ways you might not even realize were possible. If you're ready to get help for hearing loss, our large online directory of consumer-reviewed clinics is a way to find a hearing care provider near you.