Hyperacusis

Reduced tolerance to ordinary sounds

Overview

Hyperacusis is a reduced tolerance to everyday sounds, such that ordinary noises like clattering dishes, conversation, or traffic seem uncomfortably or painfully loud. It often occurs together with tinnitus and can follow noise trauma, head injury, ear surgery, or conditions such as migraine, Bell palsy, and Williams syndrome. The leading explanation is increased central gain, with the auditory brain amplifying incoming signals, rather than a problem in the ear itself. A related form, sometimes called noxacusis, involves actual pain from sound. Habitual overuse of ear protection in quiet everyday settings is thought to reinforce sensitivity, which is why sound therapy approaches use gradual exposure to restore tolerance. Cognitive behavioural therapy addresses the fear and avoidance that can maintain the problem. Uncomfortable loudness levels can be measured audiologically to track it. Severe hyperacusis can be socially disabling, limiting work, travel, and time in restaurants or other busy places.