Disclaimer: all information presented in this article is for informational purposes only. We do not promote nor endorse any of the treatments discussed on our website. 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. Relying on information provided by this website is done at your own risk.
There are multiple treatments options for hyperacusis, but there have been very few randomized controlled trials to support the effectiveness of these treatments. Most studies also do not subtype hyperacusis cases and instead use the umbrella term hyperacusis. We will discuss the latest scientific developments on several treatment options for pain and loudness hyperacusis on this page.
But importantly, we feel that actual patient experiences with these treatments are equally important to provide. Our aim is not to dismiss the potential benefits these treatments have, but to show that the actual lived experiences often do not live up to the results shown in the literature and can even have unintended consequences. We will indicate when sources are academic or anecdotal; we do stress that what is written in the anecdotal parts is not evidence-based.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a psychotherapy treatment that intends to treat hyperacusis by modifying patients’ unhelpful thoughts and behavior. There are various studies demonstrating positive effects from CBT (e.g. Aazh et al., 2024; Casrson, 2024; Aazh et al., 2016; Jüris et al., 2014, Aazh et al., 2019). One randomized controlled study with a primary focus on hyperacusis and on patients with a primary audiological complaint of hyperacusis has been conducted (Jüris et al., 2014). The study found significant between-group (different groups of participants receiving different intervention) effects in favor of the CBT group compared to the control group. The authors used the umbrella term “hyperacusis” without differentiating between subtypes and severity (in a paper published later that year).
Sound therapy
The literature
Sound therapy is the use of sound to reduce any negative effects of hyperacusis (Pienkowski, 2019). It is theorized that exposure to sound (such as white or pink noise) could treat enhancement of auditory gain which is a possible cause of hyperacusis (Henry, 2022), but that is beyond the scope of this article. Sound therapy has been the subject of multiple studies (eg Formby et al., 2024; Henry, 2022). To our knowledge, there are no studies assessing its use with randomized controlled trials, which are needed to evaluate its efficacy (Sheppard et al., 2019).
Kalsoom et al. (2024) write: There is limited evidence supporting the use of sound therapy for patients with hyperacusis. There is a further lack of evidence describing specific intervention parameters. Despite frequent use of the TRT protocol, further randomized controlled trials are required to determine the protocol’s effectiveness in treating hyperacusis. Pienkowski (2019) reports that only a handful of studies (mostly case reports), have assessed sound therapy outcomes for hyperacusis and few patients achieve complete remission of tinnitus or hyperacusis.
In a questionnaire for pain and loudness hyperacusis patients (Williams et al., 2021), 22.4% of individuals with loudness hyperacusis reported a significant improvement of symptoms from sound therapy, compared to 4.4% for those with pain hyperacusis. In contrast, 18.4% of sufferers with loudness hyperacusis reported a worsening from sound therapy, compared to 27.5% of those with pain. 32.7% of loudness hyperacusis patients and 38.5% of pain hyperacusis patients reported no positive or negative effect from sound therapy. At this moment it is not possible to determine which patients would see benefit or harm from sound therapy or cognitive behavioral therapy.
Anecdotal experiences
As Williams et al. Report, sound therapy has been harmful for some. There are various online stories; like Brian’s hyperacusis story or William’s hyperacusis story. In a thread on Reddit various users describe their positive or negative experiences with sound therapy. American audiologist Shelly Witt describes that in her experience, sound therapy worked well for most individuals with loudness hyperacusis, but some worsened significantly from it (What I have learned from my hyperacusis patients).
Medications
The literature
Abouzari et al. (2020) found that a multi-modal migraine prophylaxis therapy (treatments to reduce the frequency and severity of migraine attacks) improved hyperacusis patients’ symptoms, assessed by LDL tests and patient reporting. Other than excluding misophonia patients and those who only temporarily experience hyperacusis they did not specifically subtype during the trial, including people with ‘hypersensitivity to sound’. The study also lacked controlled placebo groups.
In the questionnaire from Williams et al. (2021), some loudness and pain hyperacusis patients reported improvements from benzodiazepines (central nervous system depressant drugs). Certain pain hyperacusis individuals (but not those with loudness) also saw benefits from opioids (strong pain medications) or gabapentinoids (a class of medications used to treat certain types of pain and epilepsy). Overall, those with pain reported benzodiazepines provided the most benefit.
Jahn et al. (2025) report for 21 individuals with pain hyperacusis: “Some patients reported modest-to-excellent effects (75–100% pain relief) from benzodiazepines (n = 3), nerve blockers (n = 2), anticonvulsants (n = 2), Tylenol (n = 1), oxycodone (n = 1).” Two people reported antidepressants were somewhat effective (50% pain relief), and seven indicated it provided no relief. It is important to note that the study provided no data for individual antidepressants. Caution with the use of benzodiazepines or oxycodone is necessary given the risk of harm, such as dependence or addiction. In a case report, aripiprazole, an atypical antipsychotic, helped one patient with noise-induced aural fullness (Goto et al., 2025).
Anecdotal experiences
We, along with other patients, have been tracking the effect of certain medications and treatments on hyperacusis in a spreadsheet. The medication clomipramine has anecdotally shown to have the most effect, but people also often report significant side effects while on the drug. Data for other antidepressants is sparse, though it seems like duloxetine might possibly also help. Ambroxol has anecdotally shown to act as a painkiller for some individuals with pain hyperacusis, results are shown in the spreadsheet.
Botox injection of the tensor veli palatini muscles
The literature
Fournier et al. (2022) report a case of complete recovery of a tensor tympani patient presenting with pain hyperacusis and ear fullness in his right, ear after a botox injection of the tensor veli palatini and levator veli palatini muscles. In Jahn et al. (2025), one patient indicated an “excellent effect (100% pain relief)” following an injection of botox in the tensor veli palatine muscle.
Anecdotal experiences
Data from the spreadsheet shows a more mixed result with this treatment option for hyperacusis.
Surgery
The literature
Round and oval window reinforcement surgery is a medical procedure which attempts to reduce the mechanical energy that is transmitted from the middle ear to the inner ear, which should increase the quality of life for hyperacusis patients. The surgery has been found to help certain individuals with hyperacusis (Silverstein et al., 2025). This surgery also lacks randomized controlled trials, and it is not known if it would be more beneficial for a certain subtype of hyperacusis.
Patient experiences
The Facebook group “Hyperacusis Surgery Talk” contains multiple patient experiences with the surgery. There are several positive outcomes talked about online (1, 2), but there are also patients who mention it did not help them (1, 2).
Manual and physiotherapy
The literature
Manual therapy can improve otological symptoms in individuals with temporomandibular disorders (Tavares et al., 2025). To our knowledge there are no studies assessing the effect of manual therapy on hyperacusis. Demoen et al. (2023) do report that neck and/or jaw movements may change hyperacusis in certain individuals. Barros Coelho et al. (2022) found that a palatal aponeurosis massage has a 75% success rate in improving tinnitus, ear pressure and ear pain. This study also does not have randomized placebo and control groups.
Patient experiences
Anecdotally, a few hyperacusis patients have reported improvements in their tolerance and symptoms from treating various neck and jaw complaints. These anecdotal reports are unfortunately written on a currently inaccessible Discord server.
Tympanic patching
The literature
With tympanic patching, a small paper patch is applied to a part of the ear drum. This reduces the strain put on the tensor tympani muscle; supposedly alleviating symptoms related to tensor tympani syndrome and certain forms of hyperacusis. One small prospective, single-blind, placebo-controlled study with 22 patients found positive results for treating ear fullness of unknown aetiology, but these patients’ symptoms corresponded to tensor tympani syndrome (Boedts, 2016).
Patient experiences
A few anecdotal experiences are gathered in the spreadsheet, mostly showing little to no effect on hyperacusis.
The use of hearing protection
The literature
To this date, no studies evaluating the effect of hearing protection such as ear plugs or muffs have been conducted specifically on hyperacusis patients. Clinicians regularly cite several studies claiming that the use of hearing protection lowers hyperacusis patients’ tolerance to sounds. A big gap in these studies is that they were tested on healthy volunteers who did not have any form of hyperacusis, ear pain or noise sensitivity.
One study reported that wearing hearing protection continuously for two weeks made participants a bit more sensitive to sound, but as stated that study was done on healthy volunteers (Formby et al., 2003). Another study found that using earplugs in one ear for seven days led to a drop in the acoustic reflex threshold (the sound level required to let the middle ear react to loud noise) of the plugged ear. The participants’ subjective categorisation of the loudness increased in both ears, meaning that they judged a given sound stimulus as louder after wearing the ear plug. Crucially, these changes mostly disappeared 24 hours after the ear plug was removed. These participants also did not have hyperacusis or noise sensitivity. (Munro et al., 2014).
Anecdotal experiences
Anecdotally, the effect of hearing protection is mixed. Various hyperacusis patients, especially those at a higher severity level, need hearing protection to maintain some quality of life. These people generally do not report their tolerance level dropping from hearing protection usage. Other patients do report their sensitivity increasing from ear plug usage, which anecdotally seems to occur more in individuals with loudness hyperacusis.
To conclude, we remark again that larger randomized controlled studies are needed to determine the effect of various treatment options. These should classify hyperacusis patients by subtype to determine which treatments are effective and which subtypes benefit the most.
A note on tests
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.
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.
Patient Stories
Below you can read some stories from patients who have experienced worsening symptoms after undergoing certain tests.
Back to square one after tympanometry test
Do not do a tympanometry test
“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.”
Tympanogram
“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?
… “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 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.”