Hyperacusis, also known as sensitive hearing, refers to a condition in which the brain’s central auditory processing center perceives noise differently, causing pain and discomfort. Individuals with hyperacusis struggle to tolerate sounds that are typically not loud to others, such as running water, traffic, walking on leaves, or operating household machines. Although all sounds can be perceived as too loud, high-frequency sounds may be particularly troublesome.
While many people experience sound sensitivity, true hyperacusis is rare, affecting approximately one in 50,000 individuals. It can occur in people of all ages and may affect one or both ears. Hyperacusis is often associated with tinnitus, a ringing sensation in the ears. It is estimated that out of the 36 million Americans who suffer from tinnitus, about one in every thousand also has hyperacusis. It is possible to have both conditions simultaneously.
Living with hyperacusis can significantly impact a person’s quality of life. Severe sound intolerance makes it difficult, and sometimes impossible, to function in everyday environments with the ambient noise present. Consequently, individuals with hyperacusis may withdraw from social activities, experience social isolation, develop a fear of normal sounds (known as phonophobia), and even face depression.
Symptoms of hyperacusis may include sensitivity to everyday sounds, initially in one ear and progressing to both ears, difficulty tolerating ordinary environments and situations, feelings of isolation, and experiencing pain or physical discomfort in response to sounds.
The exact cause of hyperacusis is often unknown, although some potential causes have been identified, including head injuries, exposure to loud noises, ear damage from toxins or medication, Lyme disease, air bag deployment, viral infections affecting the inner ear or facial nerve (Bell’s palsy), and temporomandibular joint (TMJ) syndrome. Additionally, several neurologic conditions have been associated with hyperacusis, such as post-traumatic stress disorder (PTSD), chronic fatigue syndrome, Tay-Sach’s disease, epilepsy, valium dependence, migraine headaches, depression, and anxiety.
Hyperacusis can also be observed in children with brain injuries (often accompanied by other sensory sensitivities), certain autistic children, and children with cerebral palsy.
If you suspect that you or a loved one may have hyperacusis, it is advisable to seek an evaluation from an ear, nose, and throat (ENT) specialist or otolaryngologist. The initial consultation will likely involve a comprehensive audiologic evaluation, including a hearing test, review of medical history, and a medical examination. The doctor should also provide counseling regarding their findings and discuss possible treatment options.
While there are no specific surgical or medical treatments to correct hyperacusis, sound therapy can be utilized to retrain the brain’s auditory processing center to accept everyday sounds. This therapy may involve wearing a noise-generating device on the affected ear(s) that produces a gentle, static-like sound (known as white noise), which is barely audible. Sound therapy typically takes up to 12 months to complete and often results in improved sound tolerance.
Hearing tests for hyperacusis may show normal hearing sensitivity, but this does not imply that individuals with hyperacusis hear better than others. Another type of sound sensitivity, known as “recruitment,” can coexist with hyperacusis. Recruitment is characterized by an inability to hear soft sounds coupled with distorted or intolerable perception of loud sounds. For instance, a person with recruitment may have hearing loss below 50 decibels, while sounds above 80 decibels may become intolerable, resulting in a narrow range of comfortable hearing.