Explore the multifaceted world of hyperacusis with our comprehensive article, delving into the 6 key causes of this challenging auditory condition.
Dr Edmund Farrar

Dr Edmund Farrar

Medically Reviewed by
Co-Founder & CEO of Oto

6 Causes of Hyperacusis


Hyperacusis is a hearing disorder characterised by an increased sensitivity to normal environmental sounds. These noises can cause discomfort, pain, and a severe reaction to sounds that others would find tolerable. This condition, although less common than tinnitus, affects a significant number of individuals with varying degrees of severity. Unlike the occasional irritation from loud noises, hyperacusis can make everyday activities challenging, impacting social interactions, work, and overall quality of life. But what causes this condition? Lets take a look at 6 of the most prevalent causes. 

Understanding Hyperacusis

Millions of people suffer from tinnitus, whereas only around 1 in every 50,000 suffer from hyperacusis. Whilst it might be more rare, it doesn’t make it any less problematic. The American Speech-Language-Hearing Association defines hyperacusis as a condition where everyday noises are perceived at such high volumes that they lead to irritation, anxiety, or physical pain. It can range from a minor annoyance to a debilitating condition, making even moderate sounds like a dishwasher or loud speech difficult to bear. Hyperacusis is complex, occurring on a spectrum and manifesting in different forms, often as a result of various medical conditions or injuries. But in this article we’re going to delve into the 6 most common causes of this condition. 

Global Impact

Hyperacusis is relatively rare, with its prevalence not fully understood, but it's estimated to affect between 1 to 15% of the population. It can occur in individuals of any age, including children, and tends to have a profound impact on a person's well-being. Those with hyperacusis may find themselves withdrawing from social situations to avoid discomfort, leading to isolation and a decreased quality of life. The condition can also interfere with concentration and sleep, compounding its effects on daily functioning. 

Differentiating from Related Conditions

It's important to distinguish hyperacusis from similar auditory conditions. Tinnitus, for instance, involves hearing sounds that are not present in the environment, such as ringing or buzzing in the ears. In addition, misophonia is characterised by a strong emotional reaction to specific sounds, such as chewing or breathing. Phonophobia, another related condition, is a fear of loud sounds. However, hyperacusis, whilst somewhat similar, is a different condition. Normal environmental sounds can cause discomfort and pain for sufferers. Whilst all of these conditions can coexist with hyperacusis, they are distinct in their causes and symptoms. Specific and tailored approaches are essential for proper treatment and management. 

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6 Causes of Hyperacusis

1 - Ear Pathology

The cochlea is a spiral-shaped, fluid-filled chamber located in the inner ear and is essential for hearing and engages in the conversion of sound waves into electrical signals. Damage to this part of the ear is a major cause of hyperacusis. But how do you damage the cochlear? 

Noise-Induced Trauma

Exposure to loud noises is a primary cause of cochlear damage leading to hyperacusis. This can occur from a one-time exposure to an intense sound, like an explosion, or can be the result of prolonged exposure to high decibel levels, such as in certain workplaces or through loud music. The trauma from the noise can damage the hair cells in the cochlea, which are responsible for translating sound waves into nerve signals.

Age-Related Changes

As part of the natural ageing process, the cochlea can undergo changes that may contribute to hyperacusis. The degeneration of hair cells over time can lead to increased sensitivity to certain frequencies of sound. While age-related hearing loss is more commonly associated with a decrease in hearing sensitivity, hyperacusis can also be a component of the auditory changes experienced by older adults.

2 - Migraines

How can migraines cause hyperacusis? Migraines are not just severe headaches, they are complex neurological events that can affect various sensory perceptions, including hearing. Individuals who suffer from migraines may experience hyperacusis as a symptom during or between migraine episodes. The exact mechanism linking migraines to hyperacusis is not fully understood, but it is believed to involve the central auditory pathways in the brain that process sound. 

Sensory Processing Disruptions

During a migraine, the brain's sensory processing can become disrupted, leading to an increased sensitivity to stimuli. This can make ordinary sounds seem intolerably loud or painful. The heightened activity in the neural pathways can cause a misinterpretation of the volume and intensity of sounds. It’s no surprise that many sufferers from a migraine find solace in a dark and quiet room. 

3 - Bell's Palsy

Bell's Palsy is a condition characterised by the sudden onset of facial paralysis or weakness, which typically affects one side of the face. This condition can impact the ear and hearing due to its effect on the facial nerve, which is responsible for facial movements, and also carries some fibres that influence the middle ear muscles.

Facial Nerve Involvement

The facial nerve, or cranial nerve VII, is involved in controlling the muscles of facial expression. When Bell's Palsy occurs, inflammation or compression of this nerve can lead to a disruption of normal function. Since the facial nerve also affects the stapedius muscle in the ear, which helps control the response to sound, paralysis of this muscle can result in hyperacusis.

Disruption of Sound Modulation

The stapedius muscle acts as a sound dampener, reducing the intensity of sounds entering the ear to protect the inner ear from loud noises. Bell's Palsy can prevent this muscle from functioning properly, leading to an increased sensitivity to sound or hyperacusis. Without the modulating effect of the stapedius muscle, sounds can become uncomfortably loud or even painful.

Recovery and Treatment

Most people with Bell's Palsy recover fully with or without treatment, and as the facial nerve heals, the symptoms of hyperacusis usually diminish. However, during the recovery phase, patients may need to take measures to protect their hearing and manage sound sensitivity. This can include using earplugs or noise-cancelling headphones to control the sound environment.

4 - Meniere's Disease

Meniere's Disease is an inner ear disorder that can lead to dizzy spells (vertigo) and hearing loss. In some cases, it can also cause hyperacusis due to the changes in the inner ear fluid dynamics, which can affect hearing sensitivity.

Inner Ear Fluid Fluctuations

The inner ear contains a fluid called endolymph that helps to regulate hearing and balance. In Meniere's Disease, abnormal fluid buildup in the inner ear (endolymphatic hydrops) can lead to a fluctuation in hearing ability, tinnitus, and a sensation of fullness in the ear, alongside increased sensitivity to sound.

Auditory Overstimulation

The excessive fluid pressure in the inner ear can cause parts of the cochlea to become overstimulated, leading to hyperacusis. This overstimulation can make normal environmental sounds seem excessively loud and intrusive, contributing to discomfort and a reduced tolerance for sound.

Management and Coping Strategies

While there is no cure for Meniere's Disease, treatment focuses on managing symptoms and minimising the impact on daily life. Dietary changes, such as reducing salt intake to minimise fluid retention, can be beneficial. Diuretics may also be prescribed to reduce fluid buildup in the body, including the inner ear.

5 - Lyme Disease

Lyme Disease, caused by the bacterium Borrelia burgdorferi transmitted through tick bites, can have numerous neurological effects, including the potential to cause hyperacusis.

Neurological Complications

Lyme Disease can lead to a condition known as Lyme neuroborreliosis, which affects the nervous system. Patients may experience a range of symptoms, including nerve pain, facial palsy, and issues with memory and concentration. The disease can also affect the auditory system, potentially leading to hyperacusis as a result of nerve damage or heightened neural sensitivity.

Inflammatory Response

The body's inflammatory response to infection can affect various organs, including the auditory system. Inflammation can alter the way sound is processed in the brain, making patients more sensitive to auditory stimuli. This heightened sensitivity can manifest as hyperacusis, where normal sounds are perceived as uncomfortably loud or even painful.

Treatment and Recovery

The primary treatment for Lyme Disease is antibiotics, which can typically resolve the infection and its associated symptoms, including hyperacusis. However, if hyperacusis persists, patients may need to explore additional treatments such as sound therapy or cognitive-behavioural therapy to manage their sound sensitivity. Early diagnosis and treatment of Lyme Disease are crucial in preventing long-term complications. For those with persistent hyperacusis after treatment, a multidisciplinary approach involving audiologists, neurologists, and therapists may be necessary to effectively manage the condition and improve the quality of life.

6 - TMJ Disorder

Temporomandibular Joint Disorder (TMJ) is a condition affecting the jaw joint and muscles controlling jaw movement. It's known for causing pain and discomfort, but it can also contribute to hyperacusis in some individuals.

Connection to Hyperacusis

The temporomandibular joint is located near the ears, and any dysfunction in this joint can have an impact on the auditory system. TMJ can cause a variety of auditory symptoms, including tinnitus (ringing in the ears), ear pain, and hyperacusis. The exact mechanism linking TMJ to hyperacusis isn't fully understood, but it may involve shared nerve pathways or the heightened tension in muscles around the ear.

Symptoms and Diagnosis

Individuals with TMJ may report a range of symptoms, such as jaw pain, difficulty chewing, and a clicking or popping sound when moving the jaw. When hyperacusis is present, these symptoms may be accompanied by a sensitivity to sound. Diagnosing TMJ involves a physical examination of the jaw and may include imaging tests to assess the condition of the joint.

Treatment Approaches

Treating TMJ may involve various strategies, including pain relievers, anti-inflammatory medications, and muscle relaxants. Dental splints or mouth guards can also be used to prevent teeth grinding, which can exacerbate TMJ symptoms. Physical therapy and exercises to strengthen jaw muscles are often recommended. For patients with TMJ-related hyperacusis, addressing the jaw disorder can lead to an improvement in sound sensitivity. In some cases, sound therapy or counselling may be beneficial to help manage the auditory symptoms of TMJ. A holistic approach that considers both the physical and auditory aspects of TMJ can provide the most effective relief for sufferers. 


These were 6 causes of hyperacusis. This rare but problematic condition, characterised by an increased sensitivity to normal environmental sounds, can arise from various underlying causes. From cochlear damage and migraines to TMJ disorder, the origins of hyperacusis are as diverse as they are complex. Understanding these causes is crucial for effective diagnosis and treatment. 

For those living with hyperacusis, advancements in medical research and a growing awareness of the condition offer hope for improved management strategies and a better quality of life. As we continue to explore the intricate mechanisms behind hyperacusis, the potential for more targeted and effective treatments becomes increasingly promising. 

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