Hyperacusis: noise sensitivity, causes and treatment

The NHS says that if hyperacusis is caused by another condition, such as migraines or Lyme disease, treating that condition may help. You can also be offered treatment to make you less sensitive to everyday sounds. RNID says that if no specific cause is found, specialists may be able to offer treatment to help reduce your sensitivity to sound.

Tinnitus UK adds that hyperacusis is not troublesome for most people, and in those cases an explanation and reassurance can be all that is needed. Where therapy is offered, it is usually delivered within an audiology clinic by a professional who also works with people who have tinnitus.

• Sound therapy: the NHS describes this as getting you used to everyday sounds again, which may involve wearing ear pieces or using a portable speaker that makes white noise. Tinnitus UK says the therapist slowly and gently reintroduces sound so that you can resume activities you have been avoiding.

• Cognitive behavioural therapy (CBT): the NHS says CBT changes the way you think about your hyperacusis and reduces anxiety. Tinnitus UK says it explores what makes living with hyperacusis easier or harder.

• Relaxation techniques: the NHS suggests trying relaxation techniques such as breathing exercises, and RNID says some people find these helpful.

• Treating an underlying condition in parallel: Tinnitus UK says if hyperacusis is a symptom of a specific medical condition, that condition is treated alongside.

It is understandable to want to block out sound, but the guidance is consistent. The NHS says not to wear earplugs or muffs all the time because this could make you more sensitive to noise, although short-term use may help in very noisy environments. It also says not to avoid noise completely, because this can mean you miss out on regular activities and make you more sensitive to noise.

Tinnitus UK explains why. As people avoid sound their environment becomes quieter, and the auditory system can become even more sensitive because of the lack of input. It recommends that ear protection should not be used for normal day-to-day activities, and suggests talking to a hyperacusis therapist about ways of reducing its use. RNID agrees that wearing protection for sounds that are not loud can be unhelpful in the long term.

This does not mean ignoring loud noise. RNID and Tinnitus UK both say hearing protection should still be worn around loud sounds that can damage your hearing, such as DIY tools.

Hyperacusis is a condition where tolerance to sound is reduced, according to RNID. Tinnitus UK describes it as experiencing the sounds of everyday life as intrusively loud, uncomfortable or even painful. It can affect one ear or both, and the NHS says it can come on suddenly or develop over time.

It affects people differently. RNID says for some people it does not affect them much, while for others it causes distress, affects day-to-day life and makes them want to avoid noisy places. Tinnitus UK says some people with severe hyperacusis become so afraid of sounds that they withdraw from daily activities, which can make the problem worse.

You may have hyperacusis if some everyday sounds seem much louder than they should, according to the NHS. Tinnitus UK says some people say hearing certain sounds makes it difficult to concentrate, and that they can feel tension or even anger.

Tinnitus UK also notes that tolerance varies for everyone. It changes with mood and context, and is more likely to be reduced when you are tired or stressed. For some people, though, the change in sound tolerance is severe enough to affect daily life.

• Everyday sounds feel too loud, uncomfortable or painful (NHS, RNID).

• One or both ears can be affected (NHS, RNID).

• It may come on suddenly or gradually (NHS, RNID).

• Trouble concentrating, tension or anger around certain sounds (Tinnitus UK).

• Wanting to avoid noisy places or withdrawing from activities (RNID, Tinnitus UK).

The cause of hyperacusis is unclear, according to the NHS. It can appear on its own or after hearing a sudden loud noise such as fireworks. For many people no clear reason can be identified, says Tinnitus UK. The sources list a range of conditions that can come alongside it.

• Tinnitus (NHS, RNID, Tinnitus UK). Tinnitus UK says quite a few people with tinnitus also have hyperacusis, and most people with significant hyperacusis also have tinnitus, but many have one without the other.

• Head injury, Ménière's disease, Bell's palsy, Lyme disease and Williams syndrome (NHS, Tinnitus UK).

• Migraines (NHS, RNID, Tinnitus UK).

• Autism (NHS, RNID). Tinnitus UK says hyperacusis is very common in people with autism spectrum disorder or other sensory conditions.

• Certain types of ear surgery (Tinnitus UK).

• Exposure to sudden loud noise (NHS, RNID, Tinnitus UK).

The NHS says your GP may refer you to a hearing specialist for further tests and treatment. Tinnitus UK says a formal investigation would usually be carried out by an ear, nose and throat (ENT) surgeon or audiovestibular physician, because significant hyperacusis in adults is an unusual condition and most GPs have limited experience of it.

Tinnitus UK says the specialist will ask how your sound tolerance began, about other illnesses or circumstances at the time, and about hearing loss, noise exposure and tinnitus. You may be asked to complete questionnaires about mood, hyperacusis and quality of life, your ears will be examined and you will most likely have a hearing test.

The NHS says children are often more sensitive to loud noises than adults, and that this often gets better as they get older. It adds that some children may become more sensitive to noise than others after having glue ear (where the ear fills up with fluid), or if they have another condition, such as autism.

None of the NHS, RNID or Tinnitus UK pages gives a typical duration, and they describe the experience as varying between people. The sources describe treatment as gradual: sound therapy rebuilds tolerance for sound over time, and Tinnitus UK says that for most people hyperacusis is not troublesome and reassurance may be enough. A specialist or audiology therapist can tell you what to expect in your case.

The NHS says to see a GP if everyday noises feel too loud or painful. RNID says your GP may be able to refer you to a specialist. If sounds made during sound therapy feel uncomfortably loud or cause pain, the NHS says to stop and contact your doctor for advice.

The sources reviewed for this guide do not list emergency symptoms for hyperacusis. If sudden noise sensitivity comes with other new symptoms such as hearing loss, dizziness or facial weakness, ask a GP or NHS 111 for advice.

On the NHS, the route is usually a GP appointment and then a referral to audiology or ENT, with therapy delivered in an audiology clinic. Some people see a private audiologist or ENT surgeon for quicker access. The assessment and treatment principles described above are the same, and the specialist should write to your GP.