Treatment for Hyperacusis
Sound therapy with progressive acoustic desensitization is the primary evidence-based treatment for hyperacusis, typically delivered through counseling-based programs that combine gradual sound exposure with cognitive-behavioral strategies to reduce negative reactions to everyday sounds. 1, 2, 3
Core Treatment Approach
Sound therapy forms the foundation of hyperacusis management, working through systematic desensitization to normal environmental sounds. 1, 4 The treatment operates on the principle of gradually reintroducing sound to reverse the hypersensitivity mechanisms, which likely involve disruptions in central auditory processing at the subcortical level and activation of limbic and autonomic nervous systems that produce emotional reactions like anxiety, fear, and depression. 4
Structured Counseling Programs
The most contemporary approach involves comprehensive counseling programs that address multiple dimensions of hyperacusis:
Education component: Patients receive detailed information about hyperacusis mechanisms, the auditory system, and how reactions to sound develop and can be modified. 3
Cognitive restructuring: Thought analysis and restructuring techniques help patients challenge and modify fears and negative thought patterns associated with sound exposure. 3
Coping strategies: Specific behavioral techniques are taught to reduce negative reactions to everyday sounds, including relaxation exercises and mindfulness practices. 3
Gradual sound exposure: Customized, progressive introduction of sound at tolerable levels, systematically increasing exposure over time while teaching proper (limited) use of hearing protection. 3
Sound Therapy Delivery Methods
Tinnitus Retraining Therapy (TRT) represents the established framework for acoustic stimulation, using progressive sound introduction to desensitize patients. 4 For severe cases, specific devices can be fitted:
- Noise generators: Wearable devices that provide controlled sound enrichment. 4
- Hearing aids: Can serve dual purposes when hearing loss coexists, providing both amplification and sound enrichment. 4
Treatment Duration and Format
Modern programs typically span 4 weeks of structured intervention, combining asynchronous educational content with synchronous coaching sessions. 3 This format includes videos, hands-on activities, quizzes, handouts, and regular discussion sessions to maintain engagement and reinforce learning. 3
Pharmacological Considerations
While no cure exists for hyperacusis, medications targeting serotonin metabolism may offer adjunctive benefit, given serotonin's role in related conditions like migraine and depression that frequently co-occur with hyperacusis. 4 The theoretical basis involves serotonin's potential role in central auditory processing and the hypothesis that endorphins may activate excitatory glutamate function, increasing auditory neurotransmitter toxicity. 4
Important Clinical Caveats
Hyperacusis encompasses distinct subtypes that require recognition: excessive loudness perception, annoyance reactions, fear responses, and pain with sound exposure. 2, 5 Assessment should identify which category predominates, as this may influence treatment emphasis.
Remote delivery of counseling programs addresses critical accessibility and affordability barriers that limit many patients from receiving care, making treatment more widely available. 3
Well-controlled efficacy studies remain limited—while many patients report benefit from counseling and sound therapy approaches, rigorous long-term outcome data are still needed to definitively establish treatment effectiveness. 2 However, given the debilitating nature of hyperacusis and absence of alternative evidence-based options, proceeding with sound therapy and counseling remains the most reasonable clinical approach.
Avoid overuse of hearing protection, as excessive isolation from sound can paradoxically worsen hyperacusis by further increasing auditory system sensitivity. 3 Treatment should emphasize appropriate, limited use of protection only in genuinely harmful noise environments.