How our brains respond to sound and what it means for those with hyperacusis and tinnitus

At The Audiology Place, diverse auditory challenges affect individuals and families alike. Two conditions often misunderstood yet impactful are hyperacusis and recruitment. These conditions revolve around sound sensitivity. However, they affect people differently and often go misdiagnosed or untreated due to their complexity.

We’d like to share some of this research and what it means for those who experience discomfort and distress due to everyday noises.

What is Hyperacusis?

Hyperacusis is a condition in which individuals experience heightened sensitivity to certain sounds. For people with hyperacusis, every day sounds like a ticking clock, a ringing phone, or even laughter can feel uncomfortably loud or even painful. While often associated with tinnitus (ringing in the ears), hyperacusis can exist independently. It usually reflects an issue within the brain’s auditory processing pathways, not the ear itself.

Research shows that hyperacusis may be linked to the brain’s limbic system, which governs our emotions. This connection explains why people with hyperacusis often find sounds uncomfortable and stressful. By contrast, recruitment—a different sound sensitivity phenomenon—tends to occur alongside sensorineural hearing loss and is related to damage in the cochlea rather than the brain.

Recruitment vs. Hyperacusis: Not All Sound Sensitivity is the Same

Recruitment can cause a rapid, uncomfortable increase in perceived volume for those with sensorineural hearing loss. This makes it difficult for someone to distinguish between soft and loud sounds comfortably; sounds may jump in intensity abruptly rather than gradually. Recruitment is related to damage in the hair cells of the cochlea and often comes with hearing loss. At the same time, hyperacusis may affect people with or without hearing loss.

Recruitment results from damage to specific structures in the cochlea. When certain hair cells are damaged, nearby cells may overcompensate, leading to an abnormally loud perception of sound.

Hyperacusis, however, appears to involve more complex interactions within the brain, specifically in areas responsible for processing emotions and responses to stress. This distinction is critical because it helps audiologists like those at The Audiology Place identify the most appropriate treatment pathway for each individual’s unique experience with sound.

The Brain’s Role in Sound Sensitivity

Dr. Richard Salvi and his research team at the State University of New York have been investigating the neurological roots of hyperacusis. Using imaging techniques, they discovered that certain brain parts associated with memory and emotional processing can become hyperactive in people with hyperacusis. This heightened activity is thought to amplify the emotional impact of sounds, making them seem louder and more intrusive.

Salvi’s research highlights that hyperacusis is not simply a ‘louder’ perception of sounds but a complex response involving various brain areas. This difference in how the brain processes sound makes treating hyperacusis challenging, as traditional methods used to address hearing loss may not be effective.

Advances in Treatment

Although treatment for hyperacusis and recruitment is still developing, recent trials have shown promising results. Dr Craig Formby from the University of Alabama has led studies on desensitisation techniques, where patients are gradually exposed to controlled sound levels to help their brain ‘recalibrate’ its response. This approach, often paired with counselling, aims to reduce the stress response associated with hyperacusis.

Interestingly, one study involved using sound generators with volume adjustments to help individuals with hyperacusis manage their sensitivity over time. Patients reported improved tolerance to sound and lower distress levels. This suggests that hyperacusis treatment may benefit from combining sound therapy with cognitive strategies to address the brain’s emotional response to noise.

At The Audiology Place, we stay updated on the latest research to provide personalised, evidence-based care. We offer a range of solutions, including sound therapy and counselling, to help manage conditions like hyperacusis and recruitment. Our audiologists work closely with each patient to find a treatment plan that respects their unique experience with sound and improves their quality of life.

A Compassionate Approach to Hearing Care

For those living with hyperacusis or recruitment, the world can feel unexpectedly loud and overwhelming. Our goal at The Audiology Place is to help patients understand their condition and find relief through personalised, empathetic care. Whether it’s a child with hearing sensitivity or an adult coping with tinnitus, we support the journey to better hearing health.

If you or a loved one struggles with sensitivity to sound, contact The Audiology Place today. Together, we can explore treatment options that make life quieter—and much more comfortable.

References

Jacquemin, L., van der Poel, N., Biot, L., Schollaert, J., Bonné, F., Vanderveken, O., Lammers, M., Van Rompaey, V., Gilles, A. (2023) Prevalence of tinnitus and hyperacusis in 9–12-year-old children, European Archives of Oto-Rhino-Laryngology, doi. 10.1007/s00405-023-07995-x

Formby, C., Cherri, D., Secor, C., Armstrong, S., Juneau, R., Hutchison, P., Eddins, D. (2024). Results of a 6-Month Field Trial of a Transitional Intervention for Debilitating Hyperacusis

Journal of Speech, Language, and Hearing Research; 67(6), pp1903-1931

Gold, S., Formby, C. (2017) Structured Counseling for Auditory Dynamic Range Expansion

Semin Hear 2017; 38(01): 115-129 doi: 10.1055/s-0037-1598068

Paulin, J., Andersson, L., Nordin, S. (2016). Characteristics of Hyperacusis in the General Population. Noise and Health 18(83):p 178-184, doi: 10.4103/1463-1741.189244

Potgieter, I., Fackrell, K., Kennedy, V. et al. (2020). Hyperacusis in children: a scoping review. BMC Pediatr 20, 319 https://doi.org/10.1186/s12887-020-02223-5

Ren J, Xu T, Xiang T, Pu JM, Liu L, Xiao Y and Lai D (2021) Prevalence of Hyperacusis in the General and Special Populations: A Scoping Review. Front. Neurol. 12:706555. doi: 10.3389/fneur.2021.706555

Shehabi,  A., Prendergast, G.,  Guest, H., Plack, C., (2023) Noise Exposure in Palestinian Workers Without a Diagnosis of Hearing Impairment: Relations to Speech-Perception-in-Noise Difficulties, Tinnitus, and Hyperacusis, Journal of Speech, Language, and Hearing Research, doi.10.1044/2022_JSLHR-22-00461

Wong, E., Radziwon, K., Chen, G., Liu, X., Manno, F., Manno, S., Auerbach, B., Wu, E., Salvi, R., Lau, C. (2020). Functional magnetic resonance imaging of enhanced central auditory gain and electrophysiological correlates in a behavioral model of hyperacusis,

Hearing Research, Volume 389, https://doi.org/10.1016/j.heares.2020.107908.

Dr Signe Steers

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