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List of terms related to Hyperacusis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Norina Usman, M.B.B.S[2]


Hyperacusis is a condition characterized by an over-sensitivity to a specific frequency of sound or intolerance to reasonable environmental sounds. A person with hyperacusis has difficulty accepting everyday sounds; some sounds may seem offensively loud to that person but not to others. In hyperacusis, a person gives inappropriate or exaggerated responses to sounds that are neither uncomfortable nor threatening loud to an average person; even low-intensity sounds can elicit the reaction.


Based on the symptoms, hyperacusis may be classified as cochlear and vestibular hyperacusis.[1]

Cochlear hyperacusis:

  • The most common form of hyperacusis
  • Presents with ear pain and general intolerance to any sounds that most people don't notice or consider unpleasant.
  • Crying spells or panic attacks may result from cochlear hyperacusis.
  • Most of the time cochlear hyperacusis is associated with tinnitus.

Vestibular hyperacusis:

  • Associated with dizziness, nausea, or a loss of balance triggered by certain pitch sounds.
  • Anxiety, stress, and phonophobia may be present in both types of hyperacusis.
  • High risk for developing avoidant behavior to avoid a stressful sound situation.


  • Hyperacusis can be developed because of damage to the inner ear or hearing apparatus, affecting efferent part of the auditory nerve, and fibers that come out from the brain that control sounds.[2][3]
  • In this process, tissues of the auditory nerve are damaged, though the hair cells that permit us to hear pure tones remain integral.
  • It can be as a result of injury to the neurological system of the brain. In some cases, hyperacusis may be triggered by a vestibular disorder.
  • Stapes hypermobility can also be one of the causes of peripheral hyperacusis.
  • Situations that comprise paralysis of the facial nerve (i.e., Ramsay-Hunt syndrome, Bell’s palsy, and Lyme disease) are involved in the causes of the condition.
  • Hyperacusis increases in extent during anxiety, tiredness, or stress.
  • The mechanism involved during stress, include endogenous dynorphins release into the synaptic region underneath inner hair cells.
  • It potentiates the neurotransmitter glutamate, triggering sound to be seeming with excessive noise.


Common causes of hyperacusis include:[4]

Differentiating hyperacusis from other diseases

On the basis of signs and symptoms, hyperacusis must be differentiated from misophonia, phonophobia, tinnitus, William syndrome, Lyme disease, migraine.[5][6][7][8].

Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical examination
Negative emotional reaction Ringing in the ears Psychiatric disorders Hearing loss Sound sensitivity Loudness discomfort level
Misphonia + - + +/- - - Limbic system involved Clinical diagnosis
  • Certain sounds trigger emotional or physiological responses
Phonophobia + - + +/- - - Limbic system involved Clinical diagnosis
  • Fear of loud sounds
Tinnitus +/- + - - + + 8th cranial nerve palsy/ auditory system involved Audiological exam
William Syndrome +/- - +/- + + + Genetic disorder Micro-array analysis/FISH and audiological exam
Lyme Disease + + +/- + + + Auditory system involved Audiological exam
Migraine - + - - + +/- Trigeminal ganglion stimulation Clinical diagnosis

Epidemiology and Demographics


  • The incidence of hyperacusis is approximately 1 in 50,000 people.



  • Hyperacusis is commonly seen in individuals with any age group.


  • Hyperacusis affects men and women equally.


  • There is no racial predilection to hyperacusis.

Natural History, Complications, and Prognosis

Natural History


  • Common complications of hyperacusis depend on the etiology.


  • Depending on the extent of the disease progression at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.
  • Patients with hyperacusis have profound psychological influence, patients presenting with self-harm or suicidal ideation.

Hyperausis Diagnosis

Diagnostic study of choice

Pure tone audiometry is the gold standard test for the diagnosis of hyperacusis.

  • Loudness discomfort level( LDL) measured in decibels (dB); LDL decreased by 16–18 dB than the general population is diagnostic of hyperacusis.
  • 95% of patients with hyperacusis have LDL ≤ 77 dB (average LDL in a normal person is 100 dB).

History and Symptoms

  • The hallmark of hyperacusis is sensitivity to sounds.
  • A positive history of over-sensitivity or distress to particular sounds is suggestive of hyperacusis.
  • The most common symptoms of hyperacusis include annoyance, ear pain, loudness, and tinnitus.

Physical Examination

Physical examination of patients' hyperacusis is usually remarkable for fear, irritability, and avoidance behavior.

Laboratory Findings

There are no diagnostic laboratory findings associated with hyperacusis.

CT scan

There are no CT scan findings associated with hyperacusis.


There are no MRI findings associated with hyperacusis.

Other Diagnostic Studies

Health questionnaires may be helpful in the diagnosis of hyperacusis. Findings suggestive of hyperacusis include:


The most common treatment for hyperacusis is retraining therapy that includes:[10][11][12]

  • Tinnitus Retraining Therapy (TRT), a treatment originally used to treat tinnitus, uses broadband noise to treat hyperacusis. By listening to broadband noise at soft levels for a disciplined period of time each day, patients can rebuild (i.e., re-establish) their tolerances to sound.
  • Pink noise can also be used to treat hyperacusis.

Another possible treatment include:[1]

Non- pharmacological therapy Surgical Treatment Alternative treatments
Cognitive Behavioral Therapy Round window reinforcement Excercise, yoga, meditation
Tinnitus retraining therapy (TRT) Oval window reinforcement Massage, relaxing therapy, hypnosis
Directive Counselling Vitamin and supplements


See also

External links


  1. 1.0 1.1 Baguley DM (December 2003). "Hyperacusis". J R Soc Med. 96 (12): 582–5. doi:10.1258/jrsm.96.12.582. PMC 539655. PMID 14645606.
  2. Jansen EJ, Helleman HW, Dreschler WA, de Laat JA (January 2009). "Noise induced hearing loss and other hearing complaints among musicians of symphony orchestras". Int Arch Occup Environ Health. 82 (2): 153–64. doi:10.1007/s00420-008-0317-1. PMID 18404276.
  3. 3.0 3.1 Paulin J, Andersson L, Nordin S (2016). "Characteristics of hyperacusis in the general population". Noise Health. 18 (83): 178–84. doi:10.4103/1463-1741.189244. PMC 5187659. PMID 27569405.
  4. Aazh H, Moore BCJ (2018). "Thoughts about Suicide and Self-Harm in Patients with Tinnitus and Hyperacusis". J Am Acad Audiol. 29 (3): 255–261. doi:10.3766/jaaa.16181. PMID 29488875.
  5. Schwartz P, Leyendecker J, Conlon M (November 2011). "Hyperacusis and misophonia: the lesser-known siblings of tinnitus". Minn Med. 94 (11): 42–3. PMID 22413649.
  6. Jüris L, Andersson G, Larsen HC, Ekselius L (April 2013). "Psychiatric comorbidity and personality traits in patients with hyperacusis". Int J Audiol. 52 (4): 230–5. doi:10.3109/14992027.2012.743043. PMID 23244506.
  7. Baguley DM, Axon P, Winter IM, Moffat DA (2002). "The effect of vestibular nerve section upon tinnitus". Clin Otolaryngol Allied Sci. 27 (4): 219–26. doi:10.1046/j.1365-2273.2002.00566.x. PMID 12169120.
  8. Vernon JA (1987). "Pathophysiology of tinnitus: a special case--hyperacusis and a proposed treatment". Am J Otol. 8 (3): 201–2. PMID 3631220.
  9. Tyler RS, Pienkowski M, Roncancio ER, Jun HJ, Brozoski T, Dauman N; et al. (2014). "A review of hyperacusis and future directions: part I. Definitions and manifestations". Am J Audiol. 23 (4): 402–19. doi:10.1044/2014_AJA-14-0010. PMID 25104073.
  10. Andersson G, Jüris L, Kaldo V, Baguley DM, Larsen HC, Ekselius L (2005). "[Hyperacusis--an unexplored field. Cognitive behavior therapy can relieve problems in auditory intolerance, a condition with many questions]". Lakartidningen (in Swedish). 102 (44): 3210–2. PMID 16329450.
  11. Di Stadio A, Dipietro L, Ricci G, Della Volpe A, Minni A, Greco A; et al. (2018). "Hearing Loss, Tinnitus, Hyperacusis, and Diplacusis in Professional Musicians: A Systematic Review". Int J Environ Res Public Health. 15 (10). doi:10.3390/ijerph15102120. PMC 6209930. PMID 30261653.
  12. Klein AJ, Armstrong BL, Greer MK, Brown FR (1990). "Hyperacusis and otitis media in individuals with Williams syndrome". J Speech Hear Disord. 55 (2): 339–44. doi:10.1044/jshd.5502.339. PMID 2329796.