What Is Hyperacusis?

Hyperacusis is a rare problem that causes sounds to feel abnormally loud. Everyday sounds, like washing your hands or listening to the radio, may be painfully loud. If you have hyperacusis, you may have sensitivity to sounds that others find normal. Other times, you may find regular sounds to be frightening or unpleasant.

The development of hyperacusis is not well understood, despite an estimated 3% of children and adolescents experiencing some form of hyperacusis. Fortunately, there are treatments. This article will review the common causes, types, and treatments for hyperacusis.

Types of Hyperacusis

Hyperacusis is a sensitivity to sound levels that the general population can more easily tolerate. Among the general population, sound levels become obnoxious and painful at around 100 decibels (dB). However, for someone with hyperacusis, the level where sound is obnoxious or painful can be reduced to as low as 16–18 dB.

For reference, a normal conversation measures around 60 dB, and a refrigerator hum measures approximately 40 dB. Consequently, for those with hyperacusis, most activities can trigger symptoms and often extreme sensitivity to sound.   

A healthcare provider may recommend a hearing test with an audiologist (a specialist in hearing disorders) to determine your sound tolerance. Usually, this testing can help divide hyperacusis into different categories.

There are four distinct categories of hyperacusis: loudness, annoyance, fear, and pain. These categories define the effect of sounds on a person and can often vary from person to person.

It is common for sounds to have elements of one or all categories in combination. Some sounds may appear annoying, while others may trigger physical pain. All of these can be forms of hyperacusis, and your healthcare provider may work to identify the most impactful sounds and how to reduce them.  

Causes

Hyperacusis can occur in children and adults. It is not always permanent, and it can develop at any time.

The exact causes of hyperacusis are not well understood. Some theories suggest that hyperacusis is triggered in the brain, and the origin may be where the brain interacts with the auditory system. Certain pain-signaling pathways, such as NTRK1 signaling, may also be involved in the sensitivity to sound.

Other theories suggest that the development of the structures that make up the auditory system (ear canal, tympanic membrane, stapes, and cochlea) is abnormal in hyperacusis. Because hyperacusis can vary from person to person, it likely involves several different components.   

In some cases, paralysis or disruption of the facial nerve can lead to the development of hyperacusis. Hyperacusis can develop after an inflammatory disorder impacts the facial nerve, such as Bell's palsy, or an infection, such as shingles (herpes zoster) or Lyme disease.

These conditions can affect the facial nerve, which connects the brain to the auditory system. If the inflammation is severe, this can lead to sensitivity to sound that develops into hyperacusis. Often, this form of hyperacusis self-resolves over time.

Hyperacusis is complex, and there is not one specific gene (or even a group of genes) that researchers have concretely linked to the disorder. Certain genetic syndromes, such as Williams syndrome, carry an increased risk of developing hyperacusis.

Conditions like migraines (a chronic headache disorder) and autism spectrum disorder (ASD) may also involve hyperacusis.

Signs

It can be difficult to detect how your hearing, or your child's hearing, is different from the hearing of others without testing.

Hyperacusis is very often mischaracterized, particularly in young children who can have difficulty explaining what is happening. Signs of hyperacusis can include irritability, difficulty concentrating, staying focused, and even acting out against others.

Autism spectrum disorder symptoms may include hyperacusis and sensitivity to noises. Specific areas or sounds may be particularly bothersome and trigger symptoms without a clear pretext. If you notice yourself or your child avoiding certain places, sounds, or activities, consider a hearing evaluation.

Staying on top of a child's activity and symptoms can help you identify hyperacusis as soon as possible. Because hearing is different for every person, you may notice signs or issues from hyperacusis that others do not.

Testing and Treatments

The definitive test for diagnosing hyperacusis is a hearing test (audiometric test). An audiologist performs this specialized testing, which can help determine how someone perceives sound.

The testing comprises a series of sounds played through speakers and earphones. Different sounds are presented at different volume intensities, and you are asked to respond to each sound.

After the testing is performed, the audiologist creates a report on your hearing, which you can review with a healthcare provider. The testing for hyperacusis shows sensitivity to low-volume sounds.

Treatment for hyperacusis is at first supportive. First-line treatments focus on noise reduction strategies like wearing earplugs, earmuffs, and other sound-dampening devices. Tools like noise-canceling headphones may also help reduce unwanted noise.

Sound therapy is a treatment undergoing study for hyperacusis and may apply to clinical situations. It uses a device to produce barely audible white noise (like static) in the ear. The goal is to retrain the brain's sound processing center to tolerate sound better. A person may need to wear the device for a year.

No specific surgery has been shown to correct hyperacusis. However, this remains an area of research.

Multidisciplinary Health Teams

The treatment of hyperacusis involves healthcare providers such as doctors and specialists from several disciplines. Doctors with training in ear, nose, and throat disorders (ENTs) or neurologists (specialists in conditions affecting the nervous system) are most commonly involved in treating hyperacusis.

Audiologists who perform hearing tests and assessments frequently work with ENT doctors and neurologists to help diagnose hyperacusis. Because hyperacusis is often accompanied by significant anxiety and stress around sounds, psychologists and psychiatrists may participate in care.

These specialists can collaborate to provide coordinated and specific treatment plans for your care.

Summary

Hyperacusis is oversensitivity to sounds that do not cause problems for most people. It can be seen in children or adults and may be temporary or permanent. Signs in children include irritability and avoiding certain places and situations.

Causes include migraine, infections, and conditions present at birth, such as autism spectrum disorder. A hearing test can determine whether a person has hyperacusis. Noise-reduction strategies can also help.

A Word From Verywell

Hyperacusis can have a significant burden on your life and impact your well-being, concentration, and sleep. It is normal to feel uncomfortable and know there is a physical reason behind the sensation. Fortunately, there are treatment strategies that can reduce the impact of hyperacusis to help you have a better quality of life.