Hyperacusis Management
What is Hyperacusis
Hyperacusis is not just “being annoyed by sound” — it’s an auditory sensitivity disorder, where everyday sounds are perceived as uncomfortably loud or even painful because the brain’s auditory networks are amplifying sound too much.
This amplification doesn’t reflect damage in the ear itself, but rather a change in how the brain processes incoming sound signals — in particular a part of the brain called the dorsal cochlear nucleus (DCN).
Why Normal Sounds Can Feel Too Loud
When the inner ear (the cochlea) experiences reduced or distorted input (for example, from noise exposure or hearing loss), the central auditory system compensates by increasing its sensitivity. This is sometimes called ‘central gain’ enhancement: the brain increases its “volume knob” to make up for weaker peripheral input.
In hyperacusis, this enhanced gain means normal‑level sounds trigger exaggerated responses — the brain hears them as “louder” than they should be.
Research is ongoingas to why this happens in some people and not others, but hyperacusis results from conditioned reflexes and heightened amplification of everyday sounds. This causes distress and discomfort when everyday sounds are encountered.
What Tinnitus Retraining Therapy (TRT) Does
TRT works by gradually retraining the auditory system and brain to reduce this over‑amplification and the associated emotional reactions. There are two processes involved:
1.Counselling to Change Neural Interpretation of Sound
Structured, directive counselling helps the brain learn that everyday sounds are not harmful. Over time, this reduces the emotional and stress responses that keep the hypersensitivity alive. This isn’t simply reassurance — it targets learned neural responses that reinforce sound avoidance and disability.
2.Sound Therapy to Reverse Overamplication
Sound therapy introduces controlled, low‑level background sound that:
Stimulates auditory pathways regularly,
Reduces the contrast between silence and environmental sounds,
Helps the brain recalibrate its “set‑point” for normal sound levels.
Sound therapy is an important part of TRT. The goal is to enrich your sound environment so the contrast between silence and environmental sounds decreases. This makes it easier for your brain to habituate to everyday signals. We do this via:
Wearable sound generators: small ear‑level devices (hearing aids with no microphone on) that emit a low‑level, neutral broadband sound throughout the day, personalised to your tinnitus.
These sound‑generating devices are fitted and adjusted by our audiologist, and you’ll be coached on how to use them most effectively.
This consistent sound exposure helps decrease the brains over amplification over time. It encourages the auditory system to re-adapt toward normal levels of responsiveness rather than constantly being in a heightened, sensitised state. The brain’s is highly adaptable, so it can reorganise how it responds to sound with repeated exposure in a safe and predictable context.
What to expect
We want to be realistic: TRT is not a promise for instant relief, most patients begin to notice improvements within three months, with continued progress over time. The full course of TRT typically spans 9 to 18 months, with a minimum of nine months to support long-term results and reduce the risk of symptoms returning.
Once treatment is complete, there’s usually no need for ongoing intervention. However, following our recommendations and engaging with the process—including any exercises or strategies we give you—is essential for success.
Duration of Treatment
Estimated amount of appointments:
Trial Device Fitting
Follow up at:
1-2 weeks
1 month
Then roughly every 3 months (depending on progress)
At these sessions, we check how you’re responding to sound enrichment, review your progress and adjust counselling and sound‑generator settings accordingly.
Most people undertaking TRT will engage with the therapy for 12 to 18 months, with some variation depending on individual response. Initial improvements are often noticed around the 3‑month mark, but significant habituation tends to take a year or more.
In Summary
With hyperacusis, your ears are not damaged — instead, your brain’s sound system has become over-protective, turning up the volume on everyday sounds that should feel comfortable. This can make normal noises feel overwhelming, uncomfortable, or even painful.
The TRT-based approach works by gradually retraining your brain. Through clear education and gentle sound therapy, your auditory system learns that everyday sounds are safe again. Over time, the brain’s sound “amplifier” can settle down, reducing the over-reaction and allowing your sound tolerance to improve.
This process doesn’t rely on forcing exposure or “pushing through” discomfort. Instead, it uses consistent, low-level sound and guidance to support natural desensitisation. Improvements happen gradually, often over months, as your nervous system adapts and becomes calmer around sound.
While hyperacusis can feel frightening and isolating, it is treatable. With the right support and a structured plan, many people regain confidence around sound and return to everyday activities with much greater comfort.
