Living with Hyperacusis: Coping Strategies and Treatment Options

While noise sensitivity can be extremely difficult to live with, hyperacusis is an even more extreme version. Seemingly normal, everyday sounds can seem unbearably loud to people with hyperacusis. This can include things like:

• Running water
• Rustling papers
• People talking
• A dog barking
• A dishwasher or washing machine mid-cycle
• A radio playing in the background
• A vacuum cleaner

Hyperacusis can make these sounds unpleasant to hear, and for some people, it also causes physical discomfort or even pain. You can experience it in one ear or both ears.

Hyperacusis affects around 1 in every 50,000 people, and not much is known about it. Because it’s such an uncommon condition, hyperacusis definitions vary. One researcher, Dr Richard Tyler, has categorized hyperacusis into four different subtypes: loudness, annoyance, fear, and pain: 

• Loudness hyperacusis is the definition most people use when talking about the condition. It’s when sounds that seem normal to other people seem very loud to someone with hyperacusis. 
• Annoyance hyperacusis is when someone has a negative emotional reaction to sounds, similar to misophonia.
• Fear hyperacusis causes avoidant behavior, when someone with hyperacusis has noise sensitivity anxiety. This can mean they avoid going places or become anxious when anticipating hearing triggering noises.
• Pain hyperacusis is when someone with the condition experiences pain upon hearing low-level sounds that aren’t usually problematic for people.

Dr Tyler has said that there’s a lot of crossover between the four types, and having one kind of hyperacusis may lead to developing another. He said:

“If you experience loudness hyperacusis, emotional consequences may follow, leading to stress and annoyance, which eventually lead to fear of going to events and socializing. Pain is a little more complicated because it consists of both a fundamental attribute and an emotional consequence.”

The most common symptoms of hyperacusis are sensitivity to everyday sounds and ear pain or discomfort upon hearing these noises. The pain associated with hyperacusis is sometimes called noxacusis.

This pain can be very severe, and is usually described as a stabbing or burning pain that's comparable to a root canal or nerve pain. In other words: it’s extremely painful, and can be extremely debilitating.

Additionally, people with hyperacusis may experience other distressing symptoms, such as:

• Anxiety
• Depression
• Irritability
• Difficulty in everyday environments
• Feelings of annoyance
• Panic attacks
• A feeling of fullness in the ears, similar to being on a plane
• Loss of balance
• Seizures

People with hyperacusis may avoid social situations or, in severe cases, avoid leaving the house at all in order to avoid exposure to noises that may cause them annoyance, discomfort or pain. That can lead to isolation and mental health issues.

Symptoms of hyperacusis may be worse if someone with hyperacusis is particularly tired or stressed.

Researchers are still trying to fully understand the causes of hyperacusis. Although hyperacusis causes discomfort and pain when you hear noises, it’s commonly agreed that it’s not a hearing problem, but instead is to do with how your brain perceives sounds. 

We detect sounds as vibrations, and when you have hyperacusis, your brain may perceive certain vibrations to be louder than they actually are. That’s why, when hearing low-level sounds, someone with hyperacusis reacts very differently to them than another person without hyperacusis who hears the same sounds.

In other cases, hyperacusis is a result of an accident or injury, or is a symptom of hearing loss. Other possible causes of hyperacusis include:

• Facial nerve damage: The facial nerve controls the stapedius muscle that is responsible for the regulation of sound intensity in the ear. Some people with conditions like Bell’s palsy, Lyme disease and Ramsay Hunt syndrome, which are associated with nerve damage to the face, also have hyperacusis.
• Exposure to loud noises: Some people develop hyperacusis as a result of either long-term or sudden exposure to loud noises. That means people who work in settings which expose them to sustained loud noises, like construction workers and musicians, are at risk of developing hyperacusis, as well as people who develop it after hearing a loud sound, like a gunshot or fireworks.
• Head or ear injury: For some people, hyperacusis develops after a blow to the head or another type of head injury.
• Hearing loss: Hyperacusis can develop alongside hearing loss, usually age-related hearing loss.
• Tinnitus: One study found that the occurrence of hyperacusis with severe tinnitus is as high as 80%.
• Facial or jaw surgery: If the ear nerve or facial nerve is damaged during surgery, you’re at risk of developing hyperacusis.
• Medication and recreational drugs: Some medications, like cancer drugs, can cause hearing damage and hyperacusis, and some recreational drugs like LSD also increase the risk.
• Temporomandibular joint (TMJ) disorder: If you have issues with your TMJ, you may be at risk of developing hyperacusis.
• Viral infections: Ear infections that affect the inner ear or facial nerve may cause hyperacusis.
• Autism: Research shows that hyperacusis is highly prevalent in people with autism, with one study finding that 46% of children with hyperacusis also had autism. 
• Autoimmune conditions: People with autoimmune conditions like lupus can develop hearing and balance issues, including hyperacusis, due to inner ear issues.
• Emotional stress and mental health issues: High levels of stress, as well as conditions like post-traumatic stress disorder (PTSD) and depression may cause hyperacusis and noise sensitivity.

Other conditions associated with hyperacusis include:

• Migraines
• Tay-Sachs disease
• Epilepsy 
• Myalgic encephalomyelitis or also called chronic fatigue syndrome (ME/CFS)
• Meniere’s disease
• Down syndrome
• Williams syndrome