What are the Symptoms and Signs of Hyperacusis?

Published: Apr 05, 2023

Hyperacusis is a condition in which sounds that represent normal to others seem thunderous to a person suffering from this condition. That volume can seem so loud that it is painful and stimulates anxiety, fear, or even panic. In extreme cases, certain sounds can precipitate seizures. 

The paradox is that the condition most commonly occurs due to hearing loss or injury to the auditory mechanisms. Consequently, many other problems result; depression and isolation are examples. Science has yet to identify an exact etiology for Hyperacusis.

The initial symptoms and signs of Hyperacusis may be subtle. Because the person developing an abnormal perception of sound has a mindset of having decreased hearing or deafness in one or both ears, the concept of hearing “too loud” is a mental conflict. Consequently, patients often ignore the symptoms and signs of 

Hyperacusis at the onset. Unfortunately, this delays identification and treatment. 

Another issue that lends to the confusion when Hyperacusis develops is that it may not affect all sounds. Most patients have certain frequencies or specific sound waves that stimulate enhanced perception. These intermittent or inconsistent events can delay evaluation and diagnosis.

Who Is At Risk For Hyperacusis?

Fortunately, Hyperacusis is not a common ailment. Although many people suffer from the condition, many have yet to seek medical intervention or have had a healthcare provider assess their situation that is uneducated about this unusual disorder, offering other potential factors as the culprit instead.

The National Institute of Health Publications reported the incidence of Hyperacusis at a prevalence of 0.2 – 17.2% in the general population. The “special occupational population,” including work in a loud volume environment, was 3.8-67%. Finally, the “patients with special diseases” such as Meniere’s Disease and Down Syndrome, was 4.7-95%.

Known Causes And Associated Conditions


The most common cause of Hyperacusis is hearing loss from long-term exposure to loud volume and, due to presbycusis, age-related hearing loss. However, it is also associated with many other conditions. 

Any disease or injury to the nerves involved in hearing can lead to the condition, such as the aftermath of Ramsay Hunt Syndrome, involving shingles of the facial nerve. This is important as the facial nerve affects the auditory nerves as well. 

Trauma or repeated damage to the middle ear can also result in Hyperacusis. In addition, frequent middle ear infections or disruption of the auditory ossicles (three little bones that convert sound waves to the auditory nerves) in the middle ear is a potential cause. 

Certain neurologic disorders are associated with increased sound perception. For example, certain migraine sufferers report Hyperacusis during and following a migraine attack. Similarly, patients with seizure disorders are affected more commonly.

Two congenital abnormalities, Autism, and Down Syndrome, have a higher incidence of Hyperacusis, yet the reason is not apparent. Due to communication issues and other associated symptoms of both conditions, it is harder to identify, and diagnosis may be delayed or never addressed at all.  


Tinnitus is the perception of internal sounds as if they originate from the outside world. For example, patients describe the sound as a “ringing in the ear.” Other patients report that the sound is a humming or buzzing noise. 

Four primary neurosensory conditions cause tinnitus. Age-related hearing loss, repeated exposure to loud noise, ototoxic medications, and Meniere’s disease are four causes. Therefore, it is no surprise that many people link Hyperacusis to tinnitus. 

The Hyperacusis Network states that 1 in 1,000 people with tinnitus will concurrently suffer from Hyperacusis. Over 25 million people in the United States experience tinnitus. This means that potentially 25,000 of them have Hyperacusis.


Symptoms of Hyperacusis

Many symptoms of Hyperacusis are general and are often considered “overreactive.” Initially, clinicians often refer patients with Hyperacusis for psychological evaluation. Some signs and symptoms are conditions considered the primary concern, not a manifestation of the complaint. A good example is depression. Studies report that patients who suffer from depression have a higher incidence of Hyperacusis. Or does Hyperacusis result in depression? 

Anxiety and social isolation are two early symptoms of undiagnosed Hyperacusis. When certain sounds from the environment repeatedly cause a startled, painful, or anxiety-producing response, sufferers subconsciously (or consciously) avoid the chances of such occurrences. 

Interpersonal relationship problems. Undiagnosed, Hyperacusis can significantly interfere with interpersonal relationships, ultimately contributing to withdrawal, isolation, and depression. In addition, the often volatile reaction to some sounds can be disconcerting to others who are ignorant of what causes the response. 

Signs of Hyperacusis

The signs and symptoms of Hyperacusis often develop covertly but progress over time. For example, it may start in one ear and then involve both ears. In the beginning, a patient may cope with the onset of symptoms. Unfortunately, as symptoms persist and increase, more apparent signs appear as coping mechanisms fail. 

Some signs of Hyperacusis include:

Normal sounds seem louder than the rest of the world. The water from the kitchen faucet may be annoying you out of the several other blunted sounds in the kitchen. It could be the refrigerator running, music from another room, or even a conversation with someone using an average volume. 

Exposure, especially unexpected exposure to certain sounds, causes acute anxiety, panic, or seizures. An early sign would be a fleeting feeling of physical pain and mild emotional discomfort to normal volume noise. This can progress to unbearable pain with severe panic. Seizures occur most often in response to a sudden loud noise. 

A quiet house or environment may be a zen practice. It is also a sign that music, television, fans or air conditioning, and radios are disturbing, uncomfortable, or painful to hear. 


Because the condition is uncommon and the exact cause is unidentified, many people continue to suffer undiagnosed. Hopefully, Audiology specialists are becoming more aware of Hyperacusis and are screening at-risk patients.

As important as professional education, at-risk patients should be advised and understand Hyperacusis. Knowledge is power. With adequate and truthful information, patients can advocate for themselves. 

Good outcomes in health and well-being are a joint venture. As a patient with concerns about Hyperacusis, it is vital to know the symptoms and signs of Hyperacusis.