Medicines for Hyperacusis

What it is

Hyperacusis is an increased sensitivity to everyday sounds, so that ordinary noises — which most people would find comfortable — seem uncomfortably or even painfully loud. Sounds such as running water, cutlery, traffic, children's voices, or household appliances can feel too loud, harsh, or distressing. It is different from simply disliking certain sounds; in hyperacusis, the volume itself is perceived as excessive. It can affect one or both ears, and can range from mild to severe, with more severe hyperacusis significantly affecting daily life, as people may avoid noisy situations, which can lead to isolation and anxiety. Hyperacusis often occurs alongside tinnitus (ringing in the ears), and can be associated with hearing conditions, exposure to loud noise, ear or head injury, certain neurological or other conditions, and, in some, anxiety or stress (there is often an interaction between the sound sensitivity and the emotional response to it). It is different from, though can overlap with, other sound-related conditions such as misophonia (a strong emotional reaction to specific sounds). Although hyperacusis can be very distressing, it is important to know that it is manageable, and that, in particular, over-protecting the ears from all sound (which people are often tempted to do) can actually make the sensitivity worse over time. Assessment helps identify any underlying cause and guide treatment.

How it is treated

Hyperacusis is assessed (often by audiology and sometimes ENT) to characterise the sound sensitivity, check the hearing, and identify any underlying cause. Management aims to reduce the sensitivity and distress and improve tolerance of everyday sounds, and effective approaches exist. An important principle is avoiding over-protecting the ears: while it is reasonable to protect the ears from genuinely harmful loud noise, constantly wearing earplugs or avoiding all everyday sound tends to make the ears more sensitive over time and worsen the problem — so gradual, controlled re-exposure to everyday sounds is usually part of treatment. Sound therapy is a mainstay: gradually and gently increasing exposure to everyday sounds, sometimes using controlled background sound, helps the auditory system "re-tune" and become less sensitive over time. Support to manage the anxiety and distress that often accompany hyperacusis is very valuable, and psychological approaches (such as cognitive behavioural therapy) can help, both with the emotional response and with reducing the sensitivity, especially given the strong interaction between sound sensitivity and the reaction to it. Treating any associated tinnitus or hearing condition, and any underlying cause, is part of care. Education and reassurance about the condition help. The reassuring message is that hyperacusis, though distressing, is manageable — with sound therapy (gradually building tolerance rather than over-protecting the ears), support for the associated anxiety, and treating any underlying cause — so it is well worth seeking help.