Treatment of Hyperacusis
Cognitive behavioral therapy (CBT) is the primary evidence-based treatment for hyperacusis, showing moderate to high effectiveness in reducing sound sensitivity and improving quality of life. 1
First-Line Treatment: Cognitive Behavioral Therapy
CBT should be offered as the initial treatment approach for hyperacusis, as it is the only intervention with randomized controlled trial evidence demonstrating significant improvement in loudness discomfort levels and quality of life. 1
CBT for hyperacusis addresses three core components: the physical sensitivity and pain sensations from sounds, the annoyance and distress unrelated to loudness, and the fear of being harmed by sounds that drives avoidance behaviors. 2
Treatment produces moderate to high effect sizes (Cohen's d = 0.67-0.69 for loudness discomfort levels, and d = 0.32-1.36 for secondary measures including anxiety, depression, and quality of life). 1
Benefits are maintained at 12-month follow-up, indicating durable treatment effects. 1
CBT Treatment Components
The therapeutic approach should include:
Relaxation methods to reduce physiological arousal associated with sound exposure. 2
Education and counseling about sound and the mechanisms of hyperacusis to reduce catastrophic thinking. 2
Gradual exposure to everyday sounds to desensitize patients and reduce avoidance behaviors. 2
Addressing avoidance strategies and the unmotivated use of ear protection that maintains the condition. 2
Adjunctive Sound Therapy
Sound therapy can be used as a complementary intervention, though evidence is less robust than for CBT:
Progressive introduction of sound through acoustic stimulation helps desensitize patients over several months. 3
Sound generators or hearing aids can be fitted in severe cases to deliver broadband noise for a few hours daily. 4, 3
The original approach involved partial or complete masking of sensitivity with broadband noise, though outcomes remain modest and complete remission is rare unless underlying hearing loss is addressed. 4
Various sound stimuli have been tried including narrower bands of noise, music, and nature sounds, though optimal parameters remain unclear. 5, 4
Important Clinical Considerations
A multidisciplinary setting is recommended for treatment delivery, combining psychological and audiological expertise. 2
Hyperacusis commonly co-occurs with tinnitus (9-15% general population prevalence, higher among tinnitus patients), and treatment may need to address both conditions. 3
The condition involves activation of limbic and autonomic nervous systems, producing emotional reactions including anxiety, fear, and depression that should be assessed and addressed. 3
Pathophysiological mechanisms may involve serotonin dysregulation (also implicated in migraine and depression), suggesting potential pharmacological targets, though medication evidence is limited. 3
Common Pitfalls to Avoid
Do not rely solely on sound therapy without addressing the behavioral and psychological components, as CBT has the strongest evidence base. 1
Avoid reinforcing avoidance behaviors through excessive or unmotivated use of ear protection, which maintains hypersensitivity. 2
Do not expect rapid improvement—sound therapy approaches typically require several months of consistent use. 4, 3