Noise sensitivity (hyperacusis)
Hyperacusis is a reduced tolerance of ordinary loudness. Sounds nobody else even registers come across as harsh, deafening and sometimes painful: crockery in…
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Hyperacusis is a reduced tolerance of ordinary loudness. Sounds nobody else even registers come across as harsh, deafening and sometimes painful: crockery in the sink, water from the tap, a chair scraping across the floor, a child laughing, a plastic bag rustling. Hearing itself may be perfectly normal, because what has gone wrong is not the receiving of sound but the judging of it: the system that decides how loud something was has started inflating every figure. It is a treatable condition, and the sooner it is taken in hand the less of a person's life it manages to rearrange.
What it is like from the inside
People describe it differently, and the differences matter when help is being chosen. For some the sound is simply too loud: a conversation in a café sounds like shouting. For others it turns into physical pain inside the ear — stabbing, burning or dragging — which then lingers for hours after the source has fallen silent. Others complain less about volume than about sheer unbearableness: the noise sets off an instant flare of irritation and an urge to leave the room at once.
The usual list of triggers is thoroughly ordinary: cutlery against a plate, a barking dog, the vacuum cleaner, a running engine, someone chewing, the microwave beeping, the din of a shopping centre. The sensitivity can affect one ear or both, it can arrive overnight after a loud event or build up over months so quietly that nobody can name the beginning.
After that a second ring of trouble almost always starts. The cinema and shared meals get dropped, driving stops, headphones go on at work, invitations get turned down. A permanent state of alert sets in: the ear braces itself for the next blow of sound. That alertness raises the sensitivity all by itself, so a loop forms which has to be broken separately from treating the cause.
Similar conditions handled in different ways
Telling them apart is not a formality: each is helped by different means.
- Misophonia. What grates is not the volume but a particular sound: chewing, sniffing, a clicking pen, a keyboard. Quiet chewing beside you is intolerable, loud music is not. The reaction is anger and disgust rather than pain.
- Phonophobia. Here the leading feeling is fear of sound and the anticipation of it. It commonly travels with migraine, anxiety disorders and the aftermath of concussion.
- Loudness recruitment. This one comes with hearing loss: quiet speech is missed and has to be repeated, but the moment the other person lifts their voice a little the sound becomes unbearable. There is almost no gap between "I cannot hear you" and "far too loud". What helps here is not a rest from sound but a properly fitted hearing aid.
- Tinnitus. It frequently keeps hyperacusis company, and it is often tinnitus that brings a person to the clinic in the first place. The two are usually tackled together.
Why tolerance of sound changes
Hyperacusis has no single cause. Sometimes it appears out of nowhere, but more often something from this list stands behind it.
- acoustic injury: a gunshot, a firework, a blast, a concert next to the speaker, work with a noisy tool and no ear protection;
- a head injury or concussion, in which case the sensitivity usually arrives alongside headache and fatigue;
- Ménière's disease and other inner ear disorders;
- facial nerve palsy: the muscle that damps down loud sound in the middle ear stops working, leaving that ear undefended;
- a past ear infection, shingles affecting the ear, Lyme disease;
- migraine, both during an attack and between attacks;
- features of nervous system development: autism spectrum conditions, Williams syndrome;
- long-standing anxiety, depression, exhaustion after a serious illness;
- withdrawal from certain sedative medicines, and treatment with drugs that affect the ear.
One rare cause deserves a paragraph of its own. A sharp intolerance of sound can occur in adrenal insufficiency, an uncommon hormonal illness that is dangerous precisely because it creeps up unannounced. The combination to watch for is sharpened hearing together with growing weakness, weight loss, a craving for salt, dizziness on standing, and darkening of the skin over the elbows, the creases of the palms and old scars. That combination calls for a blood test, not for better headphones.
When to be seen without delay
Sensitivity to noise on its own is not urgent, but certain combinations are looked at within days rather than whenever an appointment turns up.
- hearing in one ear has dropped sharply over hours or a day: sudden hearing loss responds far better the earlier it is treated, and the window is measured in days;
- the sensitivity arrived together with a drooping face, an eye that will not close, a rash in the ear or severe ear pain;
- it comes with marked vertigo and vomiting, or with unsteadiness on walking;
- only one ear is affected and it is not settling: a persistent one-sided problem is always investigated more closely than a two-sided one;
- everything started straight after a head injury, a dive or a flight;
- you can hear your own voice, your own footsteps or your eyes moving inside your head, a sign of a rare abnormality of the temporal bone that is only found by looking for it deliberately.
What happens at the appointment
The conversation begins with details that sound trivial and in fact steer the diagnosis: which sounds exactly are the problem, how long the unpleasant sensation lasts, whether there is pain, one ear or both, what was going on just before it started.
Then hearing is tested. Standard audiometry answers whether there is any loss, and to it is added a measurement of the level at which sound becomes uncomfortable: that figure is what describes hyperacusis itself, and it also allows improvement to be tracked objectively rather than by impression. The eardrum is examined, the movement of the chain of small bones is assessed, along with the protective reflex of the middle ear. Where the trouble is one-sided, where there is vertigo, or where an abnormality of the temporal bone is suspected, a CT or MRI scan is arranged.
Tinnitus, migraine, anxiety and disturbed sleep are asked about separately: they change the plan more than one might expect.
What helps
If a cause is found it is treated: the migraine, the infection, the inner ear disorder, the hormonal problem. Very often the sensitivity leaves along with it.
Where no clear cause emerges, the work is on tolerance itself. The foundation is sound therapy: keeping a quiet, even, thoroughly uninteresting sound in the background through the day, and raising its volume very slowly over weeks. The point is to let the hearing system get used to the ordinary range again. Sometimes small noise generators worn in the ear are used, sometimes ordinary household sound is enough. Setting the level is a specialist's job: pushing too fast produces setbacks.
The second pillar is working on the reaction to sound. Cognitive behavioural therapy takes apart the thoughts that trigger the bracing, and gradually returns a person to the situations they had been avoiding. It has the strongest evidence behind it where hyperacusis comes with tinnitus. Where anxiety or insomnia is marked, a doctor may add medication, but it serves the main work rather than replacing it.
If there is hearing loss as well, a separate task is a properly fitted hearing aid with the loud peaks limited: without one the hearing system sits in silence and the sensitivity settles in.
What you can do yourself
- do not sit in complete silence: hearing left with nothing to do tunes itself finer still;
- keep a soft, steady background at home — a fan, quiet music without sudden changes, a recording of rain;
- go back into noisy places in small steps: ten minutes in a quiet café before a concert, not the other way round;
- learn one quick way of taking the tension down; slow breathing with a lengthened out-breath works in a queue and on a bus;
- sort out sleep: someone short of it tolerates noise noticeably worse;
- tell family and colleagues that this is not a matter of temperament, and agree on simple things — closing the door, turning the volume down, not switching machinery on without warning.
The main mistake is wearing earplugs or noise-cancelling headphones all the time. Keeping them in all day feels sensible, but the result is the opposite: the more thoroughly a person walls themselves off from sound, the lower the threshold drops, and within months things that never bothered them become unbearable. Protection is for places where noise genuinely does harm: a building site, power tools, a concert, a shooting range. In ordinary life it comes off.
Sound sensitivity in children
Small children are startled by loud noise more readily than adults and put their hands over their ears; that is usually a feature of the age and it passes. It is worth a closer look when a child avoids the dining hall, noisy games or parties, flinches at household sounds, has started speaking less clearly or has stopped answering to their name.
Hearing is checked separately after an ear infection: behind a complaint that things are "too loud" there is sometimes fluid sitting behind the eardrum. In children with autism spectrum conditions intolerance of noise is common, and what it needs is not shielding from sound but gradual, signposted habituation in a predictable setting. Headphones all day are best avoided here too, for the same reason as in adults.
Online consultation
In an online appointment a doctor can go through which sounds are a problem and in what way, find out what was happening before it all began, whether there is tinnitus, vertigo or hearing loss, and look at any audiogram already done. That is enough to separate hyperacusis from misophonia and from hearing loss, to decide whether an ear specialist needs to see you promptly, and to set out the first steps of sound therapy without waiting for the queue for tests.
This material is for information only and does not replace medical advice.
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