Tinnitus and Hyperacusis- What’s the Connection?

Alexandra Costlow, Au.D

Audiologist and Tinnitus Specialist, Jefferson Health in Philadelphia, USA
March 15, 2021

Do common, everyday sounds such as dishes being put away or a door shutting seem uncomfortably loud? 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 [1].

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.  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. Here, we’ll provide information to help you understand why these sounds seem unpleasant and what can be done to improve hyperacusis and tinnitus.

The Noise Thermometer

One of the most powerful tools for sound level education is the “NoiseThermometer,” 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.

Illustration of Noise Thermometer Scale: https://hearingaidinstitute.co.za/noise-protection/

A convenient way to monitor sound levels is to use a sound level meter app such as this FREE Sound Level Meter App from the Center for Disease Control and Prevention (CDC).


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.

Appropriate hearing protection should be worn when exposed to harmful sounds

Sound Therapy

Similar to how masking noise 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.  Pink noise can be streamed through the Oto app, or on YouTube if you prefer sound therapy with visuals.  


Cognitive Behavioral 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, the patient becomes less emotionally affected by exposure to it.  CBT enables the patient to regain control of their thoughts and beliefs and thus reduce stress.  Identifying sound triggers and challenging thoughts and beliefs about them is an example of a Hyperacusis Activities Treatment (Hearing Health Foundation) [2].  


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 audiological evaluation, if warranted, can identify if hearing loss is present.  


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.  


Interested in improving your tinnitus and finding out more about hyperacusis and tinnitus?

Try Oto for free today.

Oto is designed to help give you relief from tinnitus with science-backed therapy


1.    Cederroth CR, Lugo A, Edvall NK, et al.Association between Hyperacusis and Tinnitus. J Clin Med.2020;9(8):2412. Published 2020 Jul 28. doi:10.3390/jcm9082412.  Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465629/

2.     Hearing Health Foundation: https://hearinghealthfoundation.org/hyperacusis-treatment

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