What is hyperacusis?
Do normal sounds seem unbearable to you? For some people, ordinary levels of sound make their ears hurt. Known as hyperacusis, it can be a bewildering experience, both for the person who has it, and their friends and family.
Hyperacusis is defined as an abnormal sensitivity to everyday sounds resulting in pain or discomfort.
Symptoms of hyperacusis
Symptoms of hyperacusis include:
One ear may be unlike the other. If you experience dizziness or feel unsteady, you may have what's known as vestibular hyperacusis.
About a third of people who hear phantom sounds—the ringing or buzzing of tinnitus—also have hyperacusis. For them, the phantom sounds might get worse when they pass a lawnmower or hear another loud sound.
For people who experience pain, hyperacusis seems to come in spells. After being exposed to a new loud noise, you might find you have daily pain for days or weeks triggered by various noises. The pain might be a dull headache, burning, throbbing or a sharp stab. This can have a significant impact on your quality of life.
How common is hyperacusis?
Varying definitions of noise intolerance have led to a wide range in the estimates of its prevalence, with studies in Poland and Sweden, for example, finding that as many as 9 to 17 percent of the population, respectively, say that noise is a special problem for them. In the latest survey in 2014, nearly six percent of Americans reported that they live with this discomfort, according to the U.S. Centers for Disease Control and Prevention.
Noise sensitivity, misophonia and phonophobia
Hyperacusis is one among several unusual reactions to noise, and you can sometimes experience more than one. Some people are diagnosed with “noise sensitivity.” Noisy environments may give them headaches or make them tired, even if no one sound is especially loud. Many hyperacusis patients also develop an extreme dislike for a specific noise, like chewing—a problem called "misophonia." "Phonophobia" is an extreme fear of loud sound.
Hearing loss and startling at loud sounds
If you have hearing loss, you may also sometimes hear a sudden startling increase in volume in certain sounds. You likely have what's known as auditory recruitment, which is different from hyperacusis and generally not painful.
What is the difference between tinnitus and hyperacusis?
Tinnitus is a persistent ringing in the ears. The key difference is that this sound is not something anyone else can hear — it's coming from your brain. Loud sounds may make it worse.
Hyperacusis, meanwhile, is the over-amplification of sounds in your external environment. Other people can hear the sounds, just at a more normal level.
Tinnitus is very common, and it's possible for a person to have both tinnitus and hyperacusis. In some cases, the treatment is the same (see below).
Hyperacusis among veterans
Groups that have been exposed to noise pollution are more likely to say that ordinary noises bother them. One 2019 study found that nearly half of U.S. military veterans who had been exposed to blasts—and a third who didn’t say they had been exposed to blasts—reported some degree of decreased sound tolerance. In general, veterans are at increased risk for hearing loss and tinnitus.
What causes hyperacusis?
If a radio signal was poor, you might turn up the volume to compensate. Similarly, your brain’s auditory system may turn its volume control "up"—the medical name for this phenomenon is "auditory gain"—to compensate for damage to a nerve that has led to incomplete information. A loud sound really is louder to you.
Why would that happen? Causes of hyperacusis include:
An article in the journal Noise & Health reports that several illnesses are more common than usual among people with hyperacusis—and may share a joint cause or trigger hyperacusis as a symptom. These include depression, post-traumatic stress disorder (PTSD), temporomandibular joint (TMJ) disorder, Lyme disease, Tay-Sachs disease, migraines, certain kinds of epilepsy, chronic fatigue syndrome, Meniere's disease, and autism spectrum disorder.
Start with an evaluation from an ear, nose and throat (ENT) doctor to identify or rule out illnesses that may have led to hyperacusis.
To diagnose hyperacusis, they can test the level of loudness when you get discomfort. But that would just be one part of the evaluation, which is likely to include a case history covering your experience, medical history, medications, history of noise exposure and any signs of post traumatic stress disorder (PTSD) or anxiety and depression.
You may be wondering if there is a cure for your hyperacusis. In some cases, yes, but this will vary depending on the cause of your hyperacusis. For example, if you’ve had an injury, your hyperacusis might improve as you recover.
If you have hearing loss as well as suffering from hyperacusis, a hearing aid can be programmed specifically to help you, explains Dr. Ruth Reisman, an audiologist and manager for Northwell Health Lennox Hill in New York City. All of the settings should reduce the volume of loud noises and amplify softer ones to match your hearing loss.
You may need to work with a specialist in sound desensitization or sound therapy. Wearing a device on one or both ears, you’ll listen to extremely quiet static noises daily and gradually increase to higher volumes, in a process called tinnitus retraining therapy (TRT). You might see an improvement within six months to a year. Why would exposing yourself to noise help? In part because the increase in information may coax your brain to turn the volume down.
Cognitive behavioral therapy can also be helpful to treat the anxiety around your condition, especially if you have misophonia or phonophobia.
Depending on the cause of your hearing issue, there are specialized treatments. Auditory integration therapy (AIT), which involves listening to music at different volumes, is sometimes used with autism spectrum disorder patients, for example, and can also be used in people with hyperacusis.
How can you protect yourself against loud noises?
Especially if you get cycles of pain, it’s important to prevent exposure to shocks to your hearing. The simplest approach is to wear noise-cancelling headphones or earplugs. “We have patients that wear protection when they ride the subways or if they’re going to a party,” Reisman explains.
There are sophisticated ear plugs designed for musicians with volume controls and other smart earplugs made for the military.
If you must work in a noisy environment, under U.S. law known as OSHA your employer is obligated to protect you from work-related health hazards. The U.S. military gives service members everything from simple foam ear plugs to advanced plugs with small filters that allow users to hear a command while blocking the noise of explosions and machine gun fire. In the military, you might also receive a noise muff, some of which have built-in communication systems. Some helmets have noise-reducing systems and can be worn with communication ear plugs that serve as microphones.
If you have developed hearing loss, tinnitus or hyperacusis while working in a noisy environment, you may be entitled to worker’s compensation benefits. Hearing-related claims are easier to prove the younger you are—your employer may argue that some or all of your loss is related to age—so don’t put this off.