Hyperacusis

Also called Noise sensitivity, Sound sensitivity, Misophonia

Ordinary sounds that are physically painful or intolerable. Ear defenders help in the moment and make it worse if worn all the time.

What it is

Reduced tolerance of ordinary sound. Everyday noises at levels other people find unremarkable are experienced as uncomfortably loud, or as physically painful.

Several distinct things get grouped under the name. **Hyperacusis** proper is discomfort or pain from loudness. **Misophonia** is a strong emotional reaction, usually anger or distress, to specific sounds such as chewing, sniffing or tapping, regardless of volume. **Phonophobia** is fear of particular sounds. They overlap and the management differs.

It is common in autism and sensory processing differences, and it also occurs with tinnitus, after brain injury or concussion, in migraine, after noise exposure, in Bell's palsy, and in ME/CFS and long COVID.

The single most important practical point is counter-intuitive. **Wearing ear defenders or plugs continuously makes hyperacusis worse.** The auditory system recalibrates to the quiet, and tolerance falls further. Protection is for genuinely loud environments; the treatment for the rest is graded, controlled re-exposure to ordinary sound, usually with sound therapy and support from an audiologist.

Real hearing damage still needs real protection, so this is about balance rather than never using defenders.

Signs you might notice

Everyday sounds, cutlery, hand dryers, traffic, children, feeling painfully or unbearably loud.

Flinching, covering the ears, distress or anger in response to particular sounds.

Avoiding shops, restaurants, public transport, school assemblies or family meals.

Headache, ear pain or a feeling of fullness after noise exposure.

Anxiety in anticipation of noise, and increasing withdrawal from ordinary life.

Often alongside tinnitus.

Get a hearing test first. And seek prompt assessment for sudden onset of sound sensitivity, particularly with hearing loss, ear pain, facial weakness or after a head injury.

How it can affect day-to-day life

The withdrawal is the real damage. People stop going to places, and the world shrinks, and the shrinking makes the sensitivity worse.

For autistic people and children with sensory differences, sound sensitivity is a major cause of distress that gets read as behaviour. Meltdowns in supermarkets and school halls are frequently about sound.

Misophonia within families is particularly hard, because the trigger is a person eating or breathing, and it produces guilt on all sides. Naming it as a recognised condition rather than rudeness changes the conversation.

Ear defenders have become common in schools and are genuinely helpful for specific environments and harmful as a permanent solution. A planned approach with an audiologist, using them for defined situations, is the middle path.

Sleep and stress worsen tolerance, and treating anxiety alongside is part of the management rather than a dismissal.

Supporting someone well

Get a hearing test, and audiology referral for assessment.

Do not use ear defenders or plugs all day. Use them for genuinely loud environments and remove them otherwise.

Reintroduce sound gradually rather than avoiding it, ideally with audiology guidance and sound therapy.

Use low-level background sound rather than silence; complete quiet worsens tolerance.

Plan environments: quieter times of day, quieter seats, a known escape route, and warning before a loud event.

For misophonia, agree practical accommodations without blame, such as music while eating, and get proper support rather than treating it as a character flaw.

Treat anxiety and sleep in their own right.

For children, get sensory needs written into the school plan so it is not renegotiated every term.

Where to get help

A GP practice for a hearing test and audiology referral.

An audiologist with an interest in tinnitus and hyperacusis, for sound therapy.

Tinnitus UK run a helpline and cover hyperacusis.

National Autistic Society for sensory support and school strategies.