Hyperacusis: The Missing Piece in Tinnitus Care

By Dr. Jennifer Gans 

One of the biggest gaps in how we talk about tinnitus is this:

👉 We are not talking enough about hyperacusis.

And we need to.

Because a significant portion of people who are struggling with tinnitus are not just dealing with sound…

👉 they are dealing with sound sensitivity

Research and clinical observation consistently suggest that a large percentage—often cited around 60%—of people with bothersome tinnitus also experience some form of hyperacusis.

That is not a small subgroup.

That is the majority.

And if we ignore it, we misunderstand the entire experience.

 
What Is Hyperacusis—Really?

Hyperacusis is often described as:

“sound sensitivity” 
“normal sounds feel too loud” 
“everyday noises feel overwhelming or even painful” 

But that description is incomplete.

Hyperacusis is not just about loudness.

👉 It is about how the brain is interpreting sound.

Just like tinnitus.

 
The Shared Mechanism

Tinnitus and hyperacusis are not separate problems.

They are two expressions of the same underlying process:

👉 a brain that has become over-vigilant and overprotective

In tinnitus:

the brain generates a sound 
then flags it as important 

In hyperacusis:

the brain receives normal sound 
and amplifies its importance and intensity 

In both cases:

👉 the issue is not the signal
👉 it is the brain’s relationship to the signal

 
Why Hyperacusis Feels So Much Harder

Hyperacusis adds another layer of difficulty because it changes how a person moves through the world.

Now it’s not just:

“I hear something internally” 

It becomes:

“The outside world doesn’t feel safe anymore” 
People begin to:

• avoid environments
• withdraw from activities
• fear everyday sounds (dishes, traffic, voices)
• constantly monitor sound levels 

This creates a powerful loop:

• Sound feels threatening
• The brain increases vigilance
• Sensitivity increases
• Avoidance increases
• The world shrinks 

The Trap of Protection

Here is where many people get unintentionally stuck:

They try to protect themselves from sound.

And again—this makes sense.

But the brain learns something very quickly:

👉 “Sound is dangerous.”

And once the brain learns that:

it turns up the gain 
it becomes more reactive 
it becomes faster to trigger 
So the very thing meant to help…

👉 can reinforce the problem

 
Why This Matters for Treatment

This is where many traditional approaches fall short.

If we only focus on:

reducing tinnitus 
masking sound 
avoiding triggers 
We miss the larger picture.

Because:

👉 you cannot solve hyperacusis by controlling sound alone

Just like:

👉 you cannot solve tinnitus by eliminating the sound

 
The Real Target: The Nervous System

Hyperacusis is a nervous system issue.

It reflects:

heightened arousal 
increased threat detection 
reduced filtering 
a system that is “turned up too high” 

So the work becomes:

👉 regulating the system—not eliminating sound

 
Reframing Sound

The shift is not:

❌ “Sound is too loud”
❌ “I need to avoid sound”

The shift is:

👉 “My brain is reacting strongly to sound”
👉 “This reaction can change”

This is critical.

Because it moves the person from:

helpless → empowered 
reactive → responsive 
 
Tinnitus + Hyperacusis Together

When both are present, they reinforce each other:

tinnitus draws attention inward 
hyperacusis creates fear outward 
So the person feels trapped:

👉 internally and externally

This is why addressing both together is essential.

 
What Actually Helps

The path forward is not force.

It is not:

pushing through 
overwhelming the system 
ignoring distress 
And it is also not:

complete avoidance 
overprotection 
shrinking life 
It is a middle path:

1. Education

Understanding that:

nothing is damaged 
the system is overreactive, not broken 
2. Nervous System Regulation

breathing 
mindfulness 
reducing baseline arousal 
3. Gradual Re-engagement with Sound

not flooding 
not avoidance 
but gentle, consistent exposure 
4. Changing the Internal Dialogue

From:

“This is too much” 
To:

“This is uncomfortable, but I am safe” 
 
Why This Fits the Larger Model

This is why your work is so important.

Because hyperacusis makes it undeniable:

👉 this is not about sound

This is about:

perception 
interpretation 
nervous system balance 
The exact same principles apply:

tinnitus 
hyperacusis 
floaters 
intrusive sensations 
 
Final Truth

Hyperacusis is not a sign that something is wrong with the world.

👉 It is a sign that the brain is trying too hard to protect you.

And just like tinnitus:

👉 it can change

Not by controlling sound.

But by changing:

the system 
the meaning 
the response