Can Amitriptyline Cause Hypersensitivity to Noise?
Amitriptyline does not cause hyperacusis (increased noise sensitivity); rather, it is used as a treatment for auditory hypersensitivity conditions including chronic cough hypersensitivity syndrome and tinnitus, though paradoxically it can rarely cause tinnitus itself as an adverse effect.
Amitriptyline's Role in Treating Hypersensitivity Conditions
The evidence demonstrates that amitriptyline functions as a neuromodulatory agent for conditions characterized by sensory hypersensitivity:
Amitriptyline is recommended for cough hypersensitivity syndrome, where patients experience troublesome coughing triggered by low levels of thermal, mechanical, or chemical exposure—a condition analogous to auditory hypersensitivity 1
The European Respiratory Society guidelines make a conditional recommendation that neuromodulatory drugs including amitriptyline be offered to adult patients with chronic refractory cough, based on the mechanistic parallels between cough hypersensitivity syndrome and neuropathic pain 1
The mechanism involves sodium channel blockade and modulation of central sensitization pathways, which takes several weeks to achieve analgesic effect as these pathways are modulated 2
Auditory Side Effects: Tinnitus, Not Hyperacusis
The documented auditory adverse effect of amitriptyline is tinnitus (ringing in the ears), not increased sensitivity to external sounds:
Tinnitus can develop as a rare adverse effect of amitriptyline, manifesting as ringing, buzzing, clicking, or roaring noises as perceived by the patient 3
The American Academy of Otolaryngology-Head and Neck Surgery recommends baseline assessment of auditory symptoms before starting amitriptyline and regular follow-up to assess for emergence of tinnitus 3
Case reports document unilateral tinnitus after short courses of low-dose amitriptyline (as low as 50 mg/day), though this is typically associated with higher doses and prolonged administration 4
Clinical Management of Tinnitus on Amitriptyline
If tinnitus develops during amitriptyline therapy:
Consider dose reduction if clinically appropriate, evaluating for other potential causes of tinnitus and assessing the impact on quality of life 3
Perform audiological evaluation to assess for other contributing factors, as tinnitus affects 10-15% of adults in the general population, so causality with amitriptyline must be carefully evaluated 3
Cognitive behavioral therapy may help manage tinnitus-related distress, and hearing aids or other assistive devices may benefit patients with concomitant hearing loss 3
Important Distinction
There is no evidence in the medical literature that amitriptyline causes hyperacusis (hypersensitivity to normal everyday sounds). The condition of hyperacusis is treated with sound therapy and desensitization techniques 5, not caused by medications like amitriptyline. The confusion may arise because amitriptyline can cause tinnitus (internal sound perception) but does not increase sensitivity to external environmental sounds.