Our vision
Diagnosis and tests
Disclaimer: The content on this page is exclusively intended for general informational purposes and is written by patients, not by doctors or other specialists. Our content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should contact your own physician or other qualified health care provider with any questions you may have regarding your medical condition and consult them for any questions you have regarding potential tests.
Even though we make an effort to offer correct and up to date information, we cannot guarantee the completeness, accuracy, or applicability of said information. Relying on information provided by this website is done at your own risk.
We are not qualified to determine whether or not a hyperacusis patient should undergo various audiological tests; we also believe this should be judged on a case-by-case basis and by an experienced practitioner. Relying on information provided by this website is done at your own risk. When in doubt, consult your doctor or other healthcare specialist.
However, we do ask healthcare practitioners to assess the benefits and risks of tympanometry (an evaluation of the condition of the middle ear), loudness discomfort level (LDL; the lowest intensity level perceived by a hyperacusis patient to be too loud) and dynamic range (subtracting the decibel level of the quietest sound the patient can hear from the LDL threshold) testing.
Do the test results actually affect the treatment plan? It can be interesting to know a patient’s sound tolerance level, but beyond that, does it really change how the condition will be treated? Is the information gained from these tests worth the potential risk of making symptoms worse or causing a setback?
LDL tests do not always match the perceived sensitivity of the patient (Sheldrake et al., 2015). Sometimes a patient reports an LDL level comparable to those with healthy hearing (Jahn et al., 2022; Sheldrake et al., 2015). There is also evidence that the results of LDL tests and hyperacusis questionnaires are not always correlated (Meeus et al., 2010). Rycek et al. (2025) write that LDLs offer limited insights into the overall impact and consequences of hyperacusis on the patient’s life and functioning.
Since some patients tend to be more sensitive to electronic/digital audio (Jahn et al., 2025), the risk of a setback is greater when using headphones to test one’s tolerance and might not adequately reflect the overall tolerance level of the patient. These tests usually use pure tones and not “mixed” tones like everyday sounds. They are also unable to be used properly with patients who only experience delayed pain (noise-induced pain which only starts after the sound has passed, sometimes this can take hours).
Tympanometry is often used in hyperacusis patients to detect abnormalities in the middle ear. It evaluates the condition of the middle ear by placing a probe tip in the external ear canal. This probe emits a pure tone and changes the pressure in the ear. It then measures the response of the eardrum. The results of the test are plotted on a chart which is called a tympanogram.
Both tests are known in the hyperacusis and tinnitus community for being able to cause a setback (see stories below). A new air pressure sensor has been designed specifically for patients with hyperacusis and tensor tympani syndrome (Fournier et al., 2022). The device itself does not emit any sound to function, though often external sound exposure is needed to evaluate a patient’s response to the sound. The loudness of that sound can be chosen by the patient, reducing the odds of contracting a setback.
If an MRI scan is necessary, we encourage the use of “silent” MRI models. Depending on the source, these silent MRIs produce volume levels of around 80 dB, or are about 26 dB (Matsuo-Hagiyama et al., 2016) to 35.8 dB (Alibek et al., 2014) less loud than a normal MRI.
Hyperacusis questionnaires are a safe method for assessing the hyperacusis severity of an individual. But these questionnaires do not reflect the lived experiences of patients on the severe end of the condition and sometimes do not even mention pain (for example, the Khalfa questionnaire). We encourage the development of a new questionnaire which asks follow-up questions based on the given initial answers to better reflect the severity of all individuals with hyperacusis.
Anamnesis (taking a patient’s medical history) is another safe way to diagnose hyperacusis. We recommend asking the patient about his/her cause of hyperacusis and inquire about his/her sensitivity to setbacks.
Patients are often told that hearing tests are not loud enough to make hyperacusis worse. However, we assume that this reasoning reflects that hyperacusis is only related to inner ear damage and ignores the fact that the hearing system in hyperacusis patients is already sensitive or injured. In some cases, hyperacusis may involve the middle ear rather than the cochlea. We recommend informing patients that these tests could be harmful, that they have the right to decide whether or not to take the tests, and that they should feel comfortable stopping the test at any time without hesitation or shame.
Again, we do stress that it is not up to us to judge whether or not a hyperacusis patient should undergo these tests and understand that the results can be useful.
Below you can read some stories from patients who have experienced worsening symptoms after undergoing certain tests.
Back to square one after tympanometry test
“After a tympanometry test and manual ear wax cleaning I am back to square one and the volume of human speech is making me tense up, especially any frequency that sounds high or like hissing.”
“Last tympanometry test was so extremely painful I had to stop it after a few seconds. The nurse was surprised because “this test doesn’t ever generate pain” looking at me like I’m crazy. Not planning on doing it ever again if I can prevent it.”
“I am currently sitting here with my ears sore, clicking, and popping with my eustachian tube dysfunction exacerbated after I had successfully gotten it to go away for over a year. It is now back and very difficult to cope with. It has made my hyperacusis worse, and while I hope my eardrum will heal quickly and reset itself, I am not going to be able to work on the things I need to do, and I do not feel comfortable going on the trip I planned via plane unless there’s a miraculous improvement in a day or two.”
“Audiologist did it to me without my informed consent 1 year ago. In just 20 seconds it gave my right ear chronic muscle thumping that I can control and sometimes is painful. It also caused ETD symptoms e.g ear popping.”
“Yep, I had a permanent setback from the tympanogram I had done before I knew what hyperacusis was.”
“one of my audiometries had a tympanogram. It was horrible and the setback lasted a few days.”
“The Tympanogram caused a physical setback, I can control something in my right ear that causes a very loud thump. It's been 4 months with 0 improvement”
“my previous injury in the right had been re-ignited. All the good work from the steroids, undone by my ear getting shook around. If any doctors had taken my symtoms seriously / listened when I told them how my barotrauma happened, then maybe they would have thought twice about typm.” … “My setback was not from the sound though - it was the physical motion. there was no sound.”
Setback from LDL test, what to do now?
“So as title implies I got a setback in pain hyperacusis after my last ENT visit, when audiologist pulled a LDL test in middle of audiogram, because ENT marked that it needs to be done, despite me making it clear that sound causes pain.” … “I developed crackling in one of my ears, T spike, increased sensitivity, pain from talking and which is constant even in silence from time to time. I feel that muscles in my ear are constantly tense, sometimes I get one thump while sitting in silence. 6 weeks passed and I still haven't recovered.”
“It happened to me too, they make us take this kind of test which is just an aberration for someone who suffers from hyperacusis”
Quick warning about audiologists – my personal experiences (LDL test)
“I realized afterwards I pushed myself way too far and ended up being a lot more sensitive and in pain for 3 weeks after that. Horrible experience.”
“I had a similar experience in France at a “prestigious” clinic in Paris, France. I was fuming with anger.”
“I took that same test about six weeks ago and still have not recovered. ”
Tympanometry Test Made My Tinnitus Worse
“Since that appointment my tinnitus sound has changed. I hear it louder in my left ear now(that was the ear I heard nothing but a slight hiss).”
I Worsened My Tinnitus with Tympanometry & Acoustic Reflex Test
“Since then, I still feel discomfort in the right ear (feels a bit like it is blocked/oppressed) and a slight pain that comes and goes. My right ear also "clicks" louder than usual when swallowing. This night I also had a new kind of tinnitus in my right ear - some kind of waves-like. When I'm talking, I feel like I hear better with my left ear. ”
A Test (Maybe Tympanogram?) at the ENT Department Made My Tinnitus Much Worse
“I've now got a horrible whistle which is just constant for two days with no rest from it and it's not as easy to mask with music or telly as the humming tinnitus was” … “Sadly, it's as bad now as it was 11 months ago. I really don't know what I can do now”
References
Alibek, S., Vogel, M., Sun, W., Winkler, D., Baker, C. A., Burke, M., & Gloger, H. (2014). Acoustic noise reduction in MRI using Silent Scan: an initial experience. Diagnostic and interventional radiology, 20(4), 360.
Fournier, P., Paquette, S., Paleressompoulle, D., Paolino, F., Devèze, A., & Noreña, A. (2022). Contraction of the stapedius and tensor tympani muscles explored by tympanometry and pressure measurement in the external auditory canal. Hearing Research, 420, 108509.
Jahn, K. N., Hancock, K. E., Maison, S. F., & Polley, D. B. (2022). Estimated cochlear neural degeneration is associated with loudness hypersensitivity in individuals with normal audiograms. JASA Express Letters, 2(6).
Jahn, K. N., Kashiwagura, S. T., & Yousuf, M. S. (2025). Clinical phenotype and management of sound-induced pain: Insights from adults with pain hyperacusis. The journal of pain, 27, 104741.
Matsuo-Hagiyama C, Watanabe Y, Tanaka H, Takahashi H, Arisawa A, Yoshioka E, Nabatame S, Nakano S, Tomiyama N. (2016). Comparison of Silent and Conventional MR Imaging for the Evaluation of Myelination in Children. Magn Reson Med Sci.;16(3):209-216. doi: 10.2463/mrms.mp.2016-0045. Epub 2016 Oct 31. Erratum in: Magn Reson Med Sci. 2017 Oct 10;16(4):362. doi: 10.2463/mrms.err.2016-0045. PMID: 27795484; PMCID: PMC5600027.
Meeus, O. M., Spaepen, M., Ridder, D. D., & Heyning, P. H. V. de. (2010). Correlation between hyperacusis measurements in daily ENT practice. International Journal of Audiology, 49(1), 7–13. https://doi.org/10.3109/14992020903160868
Rycek, K., Keppler, H., Deklerck, A., & Dhooge, I. (2025). Difference in characteristics between tinnitus patients with and without hyperacusis according to three different definitions of hyperacusis. International journal of audiology, 1–9. Advance online publication. https://doi.org/10.1080/14992027.2025.2508736