Comprehensive Site for Hyperacusis Information
Treatment & Research

Current treatments include desensitization therapies or acoustic therapies, often combined with pharmaceutical support.


1) TRT For Hyperacusis:  Using Dr, Pawel Jastreboff's unique approach in the 1980's, fitting bilateral broadband signal generators or other sources of sound stimulation to improve tolerance levels.  His approach has been adopted at our clinic, and our data collection reflects the very high level of improvement (85%) of patients who complete the program. The use of the devices or other sound resources must be paired with regular clinic contact and assessments for best outcomes. Not every one with hyperacusis needs to be fit with sound devices, this is a situation where the audiologist will determine this upon examination and categorization.  TRT can be performed with or without the use of sound generators, and many people with hyperacusis can also gradually improve entirely on their own, over time as the body heals and improves its functioning.  For example, following a sudden noise exposure, some people may suffer temporary hyperacusis.


2) Beginning in October 2007, this clinic in Portland, Oregon,  will begin to offer the latest form of treatment for Tinnitus and Sound Sensitivity:  NEUROMONICS.  This form of treatment has its main focus on TINNITUS however it has been noted that Neuromonics also has a positive effect on hyperacusis.  It is certainly not the first choice for anyone with simple hyperacusis, as again, it is primarily an effective treatment for Tinnitus.  Develped by Dr. Paul Davis from Australia, Neuromonics has had three published clinical trial articles as well as a multi-clinic longer term study underway with data published supporting the efficacy of this unique music-based personal listening program.  The device is known as the Oasis.

3)  Dr. Johnson offers a Pink Sound Protocol Treatment, designed to assist with hyperacusis recovery using a 16 week period.  The Pink Sound Protocol will use a personal listening device with preprogrammed pink noise and a Cognitive Component of 4 monthly segments to support recovery and improvement.  This is intended to be an affordable approach to hyperacusis for those with limited resources or limited access to clinical services, and as a first step recovery program. 

Best Form of Treatment for Persistent Hyperacusis:

We advise the use of this gentle sound therapy that was developed by the well known Dr. Pawel Jastreboff as a primary treatment for hyperacusis.  Treatment is
tailored to the personal situation of each patient who enters the clinic.  Abrupt or aggressive approaches do not appear to be of high value for the hyperacusic.  Please note at this time there does not appear to be a single medication or surgery that can cure hyperacusis.  You can find a clinical audiologist close to you that can provide TRT by visiting Dr. Jastreboff's website and searching through the TRTA associate list.  Please do use that site to locate the most up to date clinics around the globe for help with Hyperacusis.

TREATMENT FOR RECRUITMENT:  The best therapy for recruiting ears is the use of specially programmed digital hearing aids that can be set to limit the amount of amplification for louder sounds that pass through the hearing aids.  Over time, the levels can often be increased.  Please consult with your local audiologist to identify and try out these types of hearing aids.

TREATMENT FOR misophonia/4S:  do visit the new provider network at to find a center near you to receive state of the art help including evaluation, diagnosis, and treatment, newer areas of treatment that are being actively explored include biofeedback, chiropractor work, relaxation therapies, behavioral science, counseling using DBT or CBT, drug therapys and many other approaches!

Current literature searches on PUB MED revealed the following new studies


Current Research and Abstract Summaries



Pro Fono. 2006 Jan-Apr;18(1):31-40.

LDLs in Normal Hearing Adults

Faculdade de Medicina da Universidade de São Paulo.

BACKGROUND: Loudness Discomfort Level (LDL), a test used in the hearing aid fitting process, has also been recommended to evaluate patients with tinnitus and/or suspect of hyperacusis. AIM: To determine LDL reference values for normal hearing individuals and to correlate the LDL to the Acoustic Reflex Threshold (ART). METHOD: LDL was investigated in 64 normal hearing subjects, with ages between 18 and 25 years (53.1% female), in the frequency threshold of 0.5 to 8KHz and for speech (non-recorded, non-standardized connected discourse). Pulsate pure tones were presented for two seconds, with a one-second interval between each presentation. The initial stimulus intensity was at 50dB and was followed by ascending presentations, of 5dB each, until the subject referred initial discomfort with loudness. The testing procedure was performed separately in each ear, and was immediately repeated at the end of the test (test and retest situation). The choice of the ear that would start the testing procedure was alternated for each subject. After that contralateral acoustic reflexes ART were measured. The presence of the ART was indicated by a minimal needle deflection (larger than 0.05ml) on the emittance equipment. RESULTS: Median varied from 86 to 98dBHL, with no statistically significant differences between gender (p > 0.11), between ears (p > 0.36) and between the test-retest situation (p > 0.34). The determination coefficients (r2) of the linear regression model revealed absence of correlation between log(LDL) and log(ART). CONCLUSION: Normal hearing individuals have LDL between 86 and 98dBHL for all of the tested stimuli. Inter-subject differences and the good reproductivity suggest that the interpretation of the test should be cautious and analyzed considering the patient's history. The test can be an useful instrument go follow-up patients. No correlation was found between LDL and ART.

HNO. 2003 Dec;51(12):1005-11.  

Schaaf H, Klofat B, Hesse G.
Tinnitus-Klinik Arolsen,

Hypersensitivity to sound is a common description of distinct nosological phenomena of peripheral and central hearing disorders, which are characterized by intense suffering from the acoustic environment.One can distinguish between recruitment accompanying inner ear hearing loss, hyperacusis with a general hypersensitivity to sound of any frequency, and phonophobia as an anxious sensitivity towards specific sound largely independent of its volume.While recruitment can be described as a peripheral reaction caused by a lack of outer hair cell moderation, hyperacusis and phonophobia represent disturbances of central auditory processing without peripheral pathology, often combined with psychosomatic reactions. Due to insufficient efferent inhibition, hyperacusis often follows psychovegetative exhaustion.In cases of phonophobia, peripheral and efferent hearing functions are usually intact, but certain learning (conditioning) processes lead to development of specific reactions and avoidance patterns to certain content-related acoustic stimuli.This article describes those different phenomena with regard to their clinical appearance, diagnostics, and possibilities for therapy.

Mult Scler. 2002 Dec;8(6):505-9. Related Articles, Links

Central hyperacusis with phonophobia in multiple sclerosis.

Weber H, Pfadenhauer K, Stohr M, Rosler A.

Department of Neurology and Clinical Neurophysiology, Klinikum Augsburg, Augsburg, Germany.

Hearing disorders are a well-described symptom in patients with multiple sclerosis (MS). Unilateral or bilateral hyperacusis or deafness in patients with normal sound audiometry is often attributed to demyelinating lesions in the central auditory pathway. Less known in MS is a central phonophobia, whereby acoustic stimuli provoke unpleasant and painful paresthesia and lead to the corresponding avoidance behaviour. In our comparison collective, patient 1 described acute shooting pain attacks in his right cheek each time set off by the ringing of the telephone. Patient 2 complained of intensified, unbearable noise sensations when hearing nonlanguage acoustic stimuli. Patient 3 noticed hearing unpleasant echoes and disorders of the directional hearing. All patients had a clinical brainstem syndrome. ENT inspection, sound audiometry and stapedius reflex were normal. All three patients had pathologically changed auditory evoked potentials (AEPs) with indications of a brainstem lesion, and in magnetic resonance imaging (MRI) demyelinating lesions in the ipsilateral pons and in the central auditory pathway. The origin we presume in case 1 is an abnormal impulse conduction from the leminiscus lateralis to the central trigeminus pathway and, in the other cases, a disturbance in the central sensory modulation. All patients developed in the further course a clinically definite MS. Having excluded peripheral causes for a hyperacusis, such as, e.g., an idiopathic facial nerve palsy or myasthenia gravis, one should always consider the possibility of MS in a case of central phonophobia. Therapeutic possibilities include the giving of serotonin reuptake inhibitors or acoustic lenses for clearly definable disturbing frequencies.

Otol Neurotol. 2001 May;22(3):321-6; discussion 326-7.

Hyperacusis: review and clinical guidelines.
Katzenell U, Segal S.
Department of Otolaryngology, Wolfson Medical Center, Holon, Israel.
OBJECTIVE: To review the current known causes of hyperacusis and the different hypotheses concerning its etiology, and to suggest clinical guidelines. DATA SOURCE: A review of the literature with the aid of the MEDLINE database, using the following key words: hyperacusis, intolerance to sound, loudness discomfort level, and phonophobia. DATA EXTRACTION: The data collected included clinical studies, case reports and laboratory studies. CONCLUSION: Hyperacusis was shown to be caused by pathologic conditions of the peripheral auditory system, diseases of the central nervous system diseases, and hormonal and infectious diseases. In some cases there was no known cause. The pathophysiology of hyperacusis probably involves a central mechanism rather than a peripheral one. Suggested clinical guidelines and treatment are discussed

Is central hyperacusis a symptom of 5-hydroxytryptamine (5-HT) dysfunction?
Marriage J, Barnes NM.

Department of Audiology, Addenbrooke's NHS Trust, Cambridge, UK.

The subjective symptom of hyperacusis is described. The terms 'hyperacusis' and 'phonophobia' are considered to be synonymous as there is no recognized distinction between these two descriptions. Peripheral auditory pathologies with associated hearing sensitivity are reviewed and the likely mechanisms underlying the hyperacusis are listed. The neurological conditions, which have been reported to occur with hyperacusis, are reviewed. A separate aetiology of central hyperacusis is therefore proposed, with a symptom profile distinct from the peripheral hyperacusis. A common factor to neurological conditions with hyperacusis, is disturbance of 5-HT (5-hydroxytryptamine) or serotonin function. The research literature on the role of 5-HT in sensory modulation (specifically auditory startle) in animals is presented. It is proposed that 5-HT dysfunction is a probable cause of increased auditory sensitivity manifested as central hyperacusis or phonophobia.


Int J Audiol. 2003 Jul;42(5):279-88.

Assessment of hearing and hearing disorders in rock/jazz musicians.
Kaharit K, Zachau G, Eklof M, Sandsjo L, Moller C.
National Institute for Working Life/West, Department of Audiology, Goteborg University, Goteborg, Sweden.

The aim of this study was to assess hearing and hearing disorders among rock/jazz musicians. One hundred and thirty-nine (43 women and 96 men) musicians participated. The results are based on pure-tone audiometry and questionnaire responses. According to our definition of hearing loss, tinnitus, hyperacusis, distortion and/or diplacusis as hearing disorders, we found disorders in 74%, of the rock/jazz musicians studied. Hearing loss, tinnitus and hyperacusis were most common, and the latter two were found significantly more frequently than in different reference populations. The women showed bilateral, significantly better hearing thresholds at 3-6 kHz than the men. Hyperacusis, and the combination of both hyperacusis and tinnitus, were found to be significantly more frequent among women than among men. Hearing loss and tinnitus were significantly more common among men than among women. It is important to evaluate all kinds of hearing problems (other than hearing loss) in musicians, since they represent an occupational group especially dependent on optimal, functional hearing. On the basis of our results, we suggest that hearing problems such as tinnitus, hyperacusis, distortion and/or diplacusis should, in addition to hearing loss, be defined as hearing disorders.

Scandinaviian Audiology 1999;28(4):219-230 Anari, Axelsson, Eliasson, Magnusson

Hypersensitivity to sound---questionnaire data, audiometry, and classification.  100 people with hypersensitivity to sound were tested and questioned.  It was found that hyperacusis strikes younger people than tinnitus, is not related strongly to noise induced hearing less, and 86% also suffer from tinnitus.  Sounds are painful and exposure can make the condition worse for some.  Headaches are common.  Usually normal hearing is present or slight high frequency loss.  Tolerance levels for sound of pure tone is less than 90 dB.  A careful history taking is advised.


Scandinavian Audiology 2000;29(1):28-36 Sammeth, Preves, Brandy

Hyperacusis: case studies and evaluation of electronic loudness suppression devices as a treatment approach.

14 patients with severe hyperacusis were given passive attenuators (earplugs) and then fitted with

experimental electronic loudness devices, custom fit and severely compressed. Many subjects found better functioning with the devices in some listening situations.


International Tinnitus Journal 1999;5(2):76-91 Sahley, Nodr, Musick

Endogenous Dynorphins: possible role in peripheral tinnitus.  A study of a neurochemical model that links a hormone called a neuromodulator, or neuroactive opioid peptide, which in turn are derived from precursor
hormones.  These hormones act in humans including the auditory system and help modulate nerve sensitivity and nerve function.  This study proposes that these hormones may be involved with inducing hyperacusis

and tinnitus by altering neural excitability.  It is stated these hormones increase during stress.


Journal of American Academy of Audiology 2000 June;11(6):295-9

Evaluation and Treatment of Severe Hyperacusis. Valente, Goebel, Duddy, Sinks, Peterein

A single case study of 57 year old male with baro-trauma (aiplane) induced severe bilateral hyperacusis with LDLs of 20-34 dB HL.  Several therapies were tried and finally he used electronic custom units.



International Tinnitu Journal 1996;2:83-89

Tinnitus - Hyperacusis and the Loudness Discomfort Level Test - A Preliminary Report. Goldstein, Shulman

42 patients were evaluated for tinnitus and hyperacusis. There was found a positive correlation between tinnitus and hyperacusis, as well as between hyperacusis and the LDL test.  Present methods of testing for hyperacusis includes pure tone audiometry, LDLs, Feldmann Masking Curves, and the Metx test for recruitment.  They suggest a classification system for hyperacusis.


Journal of American Academy of Audiology 1998 Oct;9(5):371-9

Disturbances of loudness perception.  Phillips, Carr

Review of loudness perception auditory disorders: hyperacusis, dysacusis, phonophobia.  Various mechanisms are offered and different causes are mentioned including peripheral conditions and central conditions.  It is suggested different labelling be used to show the different origins of the disorders.












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