What is Hyperacusis?

Abnormal sensitivity to everyday sound levels or noises, often sensitivity to higher pitched sounds, in the presence of essentially normal hearing.  Hyperacusis is primarily an issue of LOUDNESS, not content!  Another good term for hyperacusis is Decreased Sound Tolerance (DST).  Voices, crowds, music, and noises can be too loud for those with this condition.  Sometimes hyperacusis includes pain in the ears upon hearing these noises.

What causes this?

The most common cause of hyperacusis is noise trauma.  Exposure to sudden or very loud noises can provoke reduced sound tolerance.  The next most common cause is head injury, like whiplash or blows to the head.  Other causes can include adverse medication reactions, illnesses, hearing loss, or unknown factors. For unknown reasons, some people, when exposed to noise trauma, develop serious ear pain, otalgia, that persists.

How many people have hyperacusis?

What we do know is that about half of those who have tinnitus, have hyperacusis, too.  Then there are people who only have hyperacusis.  This number is hard to estimate!  Probably less than 1 percent of all people in the world. Much smaller is the group with painful noise induced hearing.

What does the clinic offer?

First we will conduct an evaluation for hyperacusis at the initial appointment. If present, the hyperacusis is rated in severity from mild to profound. Dr. Johnson has spent two decades evaluation pediatric and adult patients with hyperacusis, is calm and reassuring, and can answer questions and offer helpful treatment plans.

The Johnson Hyperacusis Quotient is used to rate severity and judge progress.   Testing for the hyperacusis uses the LDL test (loudness discomfort level).  This measures the level of tolerance for slowly increasing tone pips from low pitches to higher pitches.  The results are carefully recorded and each tiny piece of information is used to decide on the condition and the degree.  Patients​​ are asked to differentiate between loudness and pain in the test.  Sounds are never loud enough to cause further injury or damage.

What can be done for hyperacusis?

Hyperacusis can be improved in about 90 percent of all patients.  Using broad band sound therapy in the form of sound generators is the most common approach. Wearing them at comfortable levels for six to twelve months for 6-8 hours per day has shown to be quite effective for most patients. Sound generators are comfortable, nearly invisible, and durable. Sound generators are $1800 for a pair and can be covered by insurance if you have a hearing aid benefit.

What else is needed?

Treatment requires frequent directive educational counseling, regular follow-ups and office visits.  Skype, phone, email and texting help the patient keep in close touch with the clinic.  Please forward any auditory records to the clinic prior to your visit.

Introductory Information About Hyperacusis

Dr. Marsha A. Johnson, TRT Specialist, Audiologist, member of TRTA


Abnormal sensitivity to everyday sound levels or noises, often sensitivity to higher pitched sounds, in the presence of essentially normal hearing.


At this point in time, there have been associations with certain disease processes as well as head injuries, i.e., closed head injury, even mild in nature. Noise induced auditory system trauma is another strong candidate for creating hyperacusis, but no definitive data has been accumulated. There is also some evidence that points to a brain chemistry dysfunction with poor uptake of certain chemicals, as well as another theory in which there is a disturbance in the part of the auditory system which brings information from the brain to the ear, thereby causing faulty amplification of sounds. As you can see, there is much to be learned about this condition.


Generally speaking, about 40% of individuals who visit this clinic have hyperacusis as well as tinnitus, and about 10% of individuals who receive treatment have only hyperacusis.

Treatment Protocol:

Patients who enroll in this clinic receive special evaluation for hyperacusis at the initial evaluation. If present, the hyperacusis is rated in severity from mild (loudness discomfort level thresholds are near normal at 90+ dB at all frequencies) to profound (thresholds for loudness tolerance are nearly identical to air conducted measurements for sound detection).

The Johnson Hyperacusis Quotient is used to rate severity and judge progress. Patients who have hyperacusis identified will always receive treatment for this​​ condition first, prior to therapy for tinnitus. Dr. Pawel Jastreboff’s Habituation Therapy has been found to be the premiere treatment for hyperacusis at this time. Many patients find rapid improvement during the first 6 months of therapy.

Treatment requires intensive directive educational counseling, frequent follow-ups and office visits, and often, the use of two sound therapy devices. These devices, if prescribed, are worn at least 8 hours a day. The patient is advised to increase and maintain a constant environmental noise level, and to avoid silence.

Hyperacusis can often be found in children or young adults, and we offer a therapy for sub-categories including Soft Sound Sensitivity Syndrome, which often affects pre-pubescent children and can be very disruptive to home and school life. Children are welcome to enter our Pediatric Clinic Program to discover if our unique therapy will improve their sound tolerance. Since 1997, this clinic has pioneered in assessment and treatment of hyperacusis in children as young as 3 years old. New information will be added to this site as our clinical trials are completed.

The use of sound therapy combined with other protocols has helped over 100 children, returning them to the dinner table, to the classroom, and to a healthy social life where sound does not dominate their lives. Effective treatments are rare in this particular area, and we will be conducting more research.