Brief summary about hyperacusis

In hyperacusis the dynamic range of hearing is reduced. The ears cannot adapt to changes in loudness. Sounds are perceived as too loud, sharp or painful. The noise tolerance limit has dropped.

Hyperacusis can be measured with a UCL test or ULL test (UnComfortable Loudness test or Uncomfortable Loudness Levels test). The loudness discomfort levels (LDLs) indicate when sound is experienced as uncomfortable. At that limit sound becomes unbearable.


Painfully loud

People with hyperacusis experience sound as unbearably loud, sharp or painful. The dynamic range has been lost, that is to say: the ear can no longer quickly adapt to changing loudness.
Cutlery and washing-up noises are often experienced as unbearably painful, while someone else with a healthy dynamic range is not even aware of a fork being put on a plate or the dishwasher being loaded. For common household, garden and kitchen sounds such as dropping a spoon into a bowl, peak noise levels have been measured as high as 107 dB.


In people with hyperacusis, the noise tolerance limit has dropped. Someone with hyperacusis can handle much fewer decibels (dB). Normally someone can tolerate 80-90 dB well. For people with hyperacusis, this noise tolerance threshold drops significantly, often to 60 dB or lower, at any frequency, about the volume of a normal conversation with someone.

People describe hyperacusis as 'living with an inner volume knob that is permanently set to too loud'.

A person with hyperacusis does not necessarily have hearing loss. If someone with hyperacusis does have hearing loss, it is called 'recruitment'. Recruitment involves a damaged inner ear.


There is a classification system for hearing.
It is suggested to use a similar table for hyperacusis, see below:


Hyperacusis Dynamic Range Loudness Discomfort Level
No hyperacusis 60 dB or higher at any frequency 90 dB or higher at any frequency
Mild hyperacusis 50 - 55 dB at any frequency 80 dB at two or more frequencies
Moderate hyperacusis 40 - 45 dB at any frequency 65 - 70 dB at two or more frequencies
Severe hyperacusis 35 dB or less at any frequency 60 dB or higher at two or more frequencies


Characteristics of hyperacusis

  • Feeling uncomfortable with noise
  • People who suffer from this may cover their ears or try to get away from the noise
  • People who suffer from this may be angry, tense, sad or anxious when they hear noise
  • People experience sound as painful, sharp or unbearably loud
  • Noise tolerance limit has dropped
  • Dynamic range of hearing is reduced, ears cannot adapt to changes in volume



Research into the causes is still ongoing, but not everything is known.

  • Exposure, past and present, to loud noise, for example in the workplace, but also exposure to loud music
  • Damage to the hearing organ
  • An operation on the ear
  • Chronic ear infection
  • Flushing out the ear that was done carelessly
  • Too long and intensive use of earplugs or noise-canceling headphones
  • Damage to the nervous system
  • Head and brain injuries, including whiplash
  • Brain tumor
  • Due to the use of certain medications
  • Problems with the jaw joint (e.g. Cranio Mandibular Joint (CMD)
  • Autoimmune diseases
  • CPRS – complex regional pain syndrome.
  • Heredity
  • Lyme disease (caused by a tick bite)


Furthermore, hyperacusis can be a symptom of:

  • Migraine
  • Meniere's disease (attacks of vertigo, poor hearing and tinnitus)
  • Bell's Palsy (acute facial nerve paralysis)
  • William's Syndrome/Williams Beuren syndrome (delayed development, heart defect and behavioral problems)
  • Tay-Sachs disease (metabolic disease)
  • Chronic pain syndromes / Fibromyalgia (non-joint related chronic muscle-connective tissue pain and pressure point pain / soft tissue rheumatism)
  • Acoustic Shock Syndrome
  • Autism. According to American research, 40% of people with autism spectrum disorder are hypersensitive to loud sounds
  • ADHD
  • Some crying babies seem to be sensitive to sounds, with or without other factors


Hyperacusis is not the same as noise overstimulation

Many people think that noise is overstimulation and hyperacusis are the same. That is not true.
A mixture of hyperacusis and sound overstimulation may arise after brain injury. It also occurs separately.

The two concepts are summarized under the unclear heading 'noise hypersensitivity'.


Overstimulation by sound means that people cannot separate sounds properly, background noise immediately appears as foreground noise, all sounds can be experienced as one mess, but people who suffer from overstimulation by sound are not necessarily bothered by volume. In the UCL test (uncomfortable loudness test), people with only noise overstimulation do not appear to have an abnormal score. The noise tolerance limit has not dropped.
Following a conversation in noise is impossible. It is impossible to understand what is being said if someone else is talking in the same room at the same time.
When people who suffer sensory overstimulation are tired or busy, they cannot tolerate any sound at all. A stacking effect occurs between other forms of sensory and cognitive overstimulation. It is a common disabling and socially isolating consequence of brain injury.

Rest and stopping background noise are the only remedies.


In people with sensory overstimulation, unlike in people with hyperacusis, sound does not hurt the ears.



There are many variations of hyperacusis that have different causes in the head and different symptoms.

  • Low frequency noise annoyance (sensitive to low frequency noise (lfg) with a frequency up to 125 Hz)
  • Sensitive to high frequency sound
  • Recruitment (with hearing loss)
  • Hyperacusis Willisii (ossicles grow together; otosclerosis)
  • Dysacusis (distortion of sound, echo sensation, possibly pressure sensation)
  • Diplacusis (sound is perceived differently by both ears and at a different pitch)
  • Vestibular hyperacusis (dizziness due to sound)
  • Peripheral hyperacusis (on one side/ear)
  • Mechanical hyperacusis (muscles or ossicles too weak or too tight)
  • Serotonin levels in depression too low
  • Hypersensitive hearing (certain frequencies are not tolerated and volume is not a problem)
  • Mysophonia/phonophonia (disgust with certain sounds, read more...)



There is still some discussion about the treatment of hyperacusis. "Treatment" may mean that a person learns to deal with the consequences of hyperacusis.


The treatment may include:


  • Cognitive behavioral therapy - intended to help discover and change:
    • the way someone thinks about sound
    • to reduce suffering
    • changing avoidance behavior
    • counseling and education - to support and help learn more about hyperacusis
  • Sound therapy (desensitization) - this is intended to make the hearing less sensitive to sound for several months, using special noise generators either in the home or in the ears (masking device similar to hearing aids)
  • Lifestyle changes - including learning relaxation techniques, listening to soothing music or sounds, avoiding noisy situations, and not using earplugs or earmuffs (these can make the ears more sensitive)

In certain situations, use aids such as: noise canceling or earplugs.



Hyperacusis, literally translated from the Greek for 'too much hearing', often occurs in combination with tinnitus.

The word 'tinnitus', or ringing in the ears, is derived from the Latin word for 'ringing'. It is hearing damage and includes various sounds that cannot be heard outside the head: whistling, buzzing, hissing, ringing or humming up to and including waterfall sounds.

If the cilia in the ear are damaged, you will either hear worse or they transmit the wrong information, such as a beep, hum or noise.


There may be several causes for tinnitus:

  • noise exposure (above 80 decibels)
  • stress, psychological overload (trauma, threats, tensions, burn-out, worries, informal care, lack of sleep, etc.)
  • hearing loss (sudden, gradual, Meniere's, bridge angle tumor, ear plug, congenital, etc.)
  • loss of physical condition (exhaustion, prolonged drug or alcohol use, lack of sleep, anesthesia, illness, etc.)
  • high blood pressure
  • infectious diseases
  • side effect of medications


Listen carefully!

We noticed that there is confusion about sound problems caused by brain injury.

We hope that this page has highlighted the differences between:



Hersenletsel-uitleg.nl en Project-overprikkeling.nl


Mijn leven met chronische lyme, Hoorzaken,

Stichting Hoormij,

Hyperacusis network,


Green DS: Pure tone air conduction testing. In: Handbook of Clinical Audiology, Edited by J. Katz, Baltimore, Williamsand Wilkins, 98-109, 1978.


Reich GE, Griest SE: A survey of hyperacusis patients. In: Tinnitus 91 , Proceedings of the Fourth International TinnitusSeminar. Edited by JM Aran and R. Dauman, Amsterdam, Kugl er Publications, 249-253, 1992Vernon 1:

Recruitment/when noise spells pain. The Voice, 12,37, June/July 1991