Do common, everyday sounds such as dishes being put away or a door shutting seem uncomfortably loud? If this is a regular ocurrence for you then you may have something called hyperacusis. This articles explains what is hyperacusis, how it is linked to tinnitus and how it can be treated.
Alexandra Costlow, Au.D

Alexandra Costlow, Au.D

Medically Reviewed by
Dr Jameel Muzaffar
Audiologist and Tinnitus Specialist
March 15, 2021

What is Hyperacusis and is it Linked to Tinnitus?

Do common, everyday sounds such as dishes being put away or a door shutting seem uncomfortably loud? If this is a regular occurrence for you then you may have something called hyperacusis.

Hyperacusis is defined by having reduced sound tolerance to everyday sounds, and it actually commonly occurs with tinnitus. Read on to find out what is hyperacusis and how it is linked to tinnitus.

What is Hyperacusis?

The inability to tolerate the normal range of sound from very soft to loud (up to approximately 100dB) is referred to as hyperacusis. Tinnitus and hyperacusis often co-occur, and recent research suggests that the prevalence of hyperacusis increases as the severity of the tinnitus increases, and as many as 80% of people with severe tinnitus also have hyperacusis.

What Does Hyperacusis Feel Like?

People who experience hyperacusis may report that everyday sounds are uncomfortably loud, “trigger” or exacerbate tinnitus, “make them jump”, cause ear pain or discomfort, or fear that they are damaging the ear or hearing.  

Having hyperacusis can feel isolating as you may avoid attending social events that you used to enjoy due to fear or exposure to loud sound. This may lead you to feel depressed or anxious.

The good news is that although some sounds may seem uncomfortable, most everyday sounds won’t actually damage the hearing. Like tinnitus, there are many ways to manage hyperacusis and often it takes a combined approach of several treatments overtime to regain normal sound sensitivity.

But what can be done to treat or improve hyperacusis?

The Noise Thermometer

One of the most powerful tools for sound level education is the “Noise Thermometer,” which provides examples of soft, normal, loud, and dangerous noise levels.  

Whether a sound is potentially harmful depends on both the intensity level and the amount of time that the listener is exposed to it.  Although the sound of a vacuum cleaner may be unpleasant or bothersome, it would take hours of exposure to damage hearing.  A noisy jackhammer however would be expected to damage hearing after only 15 minutes of exposure.  

Referring to a noise thermometer can help to identify which sounds may actually be harmful versus which sounds are simply unpleasant.

The Noise Thermometer Scale can help with Hyperacusis
The Noise Thermometer Scale. Source: Hearing Aid Institute

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How to Measure Noise Exposure

You may want to measure the loudness of sound at loud events such as a concert, sporting event, wedding, or during activities such as using power tools for construction or yard work. This can be an effective way to know whether your exposure to loud sound could be potentially harmful to your hearing.

There are a number of ways to easily and conveniently monitor sound levels. We would recommend the following methods.

Sound Level Meter App

A convenient way to monitor sound levels is to use this free Sound Level Meter App from the Center for Disease Control and Prevention (CDC). Other sound level meter apps are available for both Apple and Android devices.

Apple Watch / Smartwatch

The Apple Watch Series 4 and later will automatically measure noise exposure levels, and give you a notification if you are being exposed to dangerously loud noise levels. If you are alerted that your nose exposure has exceeded a safe listening level, you should take a break by turning off the sound source or moving to a quiet area.

To take a noise break, you do not need to be in silence. You can converse normally with other people during the noise break.


Hearing Protection

Humans are wired for sound and knowing where and when to properly use hearing protection is key!  

Reserve use of hearing protection for exposure to truly harmfully loud sounds (e.g. a sporting event or riding a motorcycle). Excessive or unwarranted use of hearing protection can reduce the range of sound that can be tolerated. Hearing protection should never be worn in quiet, or during conversation or other active listening activities. Likewise, it should never be worn 24/7.  

It is important to select the proper hearing protection based on the specific needs of the user and physical fit. Hearing protection should always feel comfortable and secure in the ears.

An important note about hearing protection is that noise cancelling headphones should be used properly as improper or excessive use can worsen sound sensitivity and tinnitus.

Appropriate hearing protection should be worn when exposed to harmful sounds
Appropriate hearing protection should be worn when exposed to harmful sounds

Sound Therapy

Sound therapy has been shown to be effective in hyperacusis as well as tinnitus.

Similar to how sound masking can mask or blend tinnitus to make it less noticeable, pink noise is the type of noise that has been found to be most effective in managing hyperacusis. Whereas white noise gives equal power to all frequencies (pitches), pink noise accentuates the frequencies that comprise speech.

If you prefer to listen to relaxing sounds with concurrent visual stimulation, YouTube offers content that offers both auditory and visual stimulation.

Sound therapy may also concurrently relieve tinnitus intrusion and improve overall quality of life.


Cognitive Behavioural Therapy (CBT)

CBT can be a powerful tool for reframing thoughts and emotions about both hyperacusis and tinnitus.

It is a common form of therapy used to treat conditions such as anxiety, post-traumatic stress disorder (PTSD), and specific phobias such as fear of public speaking or flying in an airplane. 

CBT may be applied to hyperacusis by asking the patient to define specific sound triggers, such as a car horn, and reframing the sound in a neutral or even positive light.  In this example, the patient would challenge the negative association they have with hearing a car horn to understand that the car horn will only be present for a few short seconds and then will pass (neutral) and it’s providing a measure of safety in alerting others that a car is coming (positive).  

Through reframing thoughts and beliefs about a specific sound, you'll becomes less emotionally affected by exposure to it. CBT enables you to regain control of their thoughts and beliefs and thus reduce stress.   

You can read more about CBT for tinnitus in our comprehensive guide.

Evaluation of Uncomfortable Levels (UCLs)

It may be helpful to consult a medical professional if you are experiencing severe sound sensitivity.

Audiologists can formally measure sound tolerance levels using pure tones. This allows definition of the severity of the hyperacusis as well as the ability to track improvement during and after treatment. 

Full assessment from an audiologist, if warranted, can also identify if hearing loss is present.  

If hearing aids are recommended, the audiologist will advise you regarding how to safely and comfortably regrow your sound tolerance levels and adapt to hearing aids.

An audiologist can also advise you how to properly use ear plugs so as not to worsen tinnitus.


A Multifaceted Approach

No matter which methods are pursued, it is important to remember that multiple approaches may be required to appreciate an improvement in hyperacusis and tinnitus over time.  

Improvement may be gradual, so be patient with yourself and appreciate the progress you have made so far.

Join Oto

The Oto app offers expert guidance in the palm of your hand. Reduce tinnitus and hyperacusis intrusion using the many resources the app offers:

  • CBT techniques
  • A library of various pleasant and relaxing sounds including white and pink noise
  • Meditation, breathing, and anchoring exercises
  • Exercises to promote relaxation and physical wellbeing

Check out Oto's Tinnitus Support Group, a supportive community for individuals with tinnitus and related conditions such as hyperacusis to receive regular tips and tricks from the expert team at Oto!

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