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Cochlear Hyperacusis - Causes, Types, Diagnosis, and Treatment

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Even soft sounds can cause discomfort in cochlear hyperacusis. Read the article to know more about cochlear hyperacusis.

Medically reviewed by

Dr. Satyabrata Panigrahi

Published At December 1, 2022
Reviewed AtOctober 5, 2023

What Is Hyperacusis?

Hyperacusis is an abnormal condition characterized by an increased sensitivity to ordinary sounds. As a result, there is associated pain and discomfort. The degree of hyperacusis can range from either mild pain associated with discomfort to severe pain with difficulty maintaining a regular upright posture or complete loss of balance.

What Are the Types of Hyperacusis?

Hyperacusis is of two types, namely,

  • Cochlear hyperacusis

  • Vestibular hyperacusis.

What Is Vestibular Hyperacusis?

There is balance loss or postural control loss in vestibular hyperacusis, and the individual feels like he is about to fall when there is sound exposure. It is associated with severe nausea, vertigo, mental confusion, loss of consciousness, and fatigue. It is also called audiogenic seizure disorder and Tullio's syndrome.

What Is a Cochlear Hyperacusis?

It is the most common form of hyperacusis. Ear pain, discomfort, irritation, and annoyance are seen with sound exposure in cochlear hyperacusis. Even exposure to soft sounds brings about these symptoms. Most people with cochlear hyperacusis tend to leave the room or cover their ears when exposed to sounds.

Emotional reactions, panic attacks, and crying are commonly associated with cochlear hyperacusis. As a result of cochlear hyperacusis, the affected individuals feel something wrong is happening around them, causing dissociation from reality, or confusion. Headache is a common feature of both cochlear and vestibular hyperacusis.

What Is the Pathophysiology of Cochlear Hyperacusis?

Cochlear hyperacusis is caused due to damage to the impulse conduction pathway. The regulatory mechanism for the amplification of sounds is responsible for reducing the sounds and noises heard. While in the case of cochlear hyperacusis, the amplification regulator is affected in such a way that they magnify the sounds and noises. Also, damage to the middle ear bones needed for transmitting and amplifying sounds can cause cochlear hyperacusis. In some cases, a brain-chemistry dysfunction can bring about cochlear hyperacusis.

What Causes Cochlear Hyperacusis?

Cochlear hyperacusis does not have a gender or age predisposition and can occur in all people. It is not a congenital condition. Of the many causes of cochlear hyperacusis, the following are some common causes:

  • Trauma to the head.

  • Frequent ear infections.

  • Surgeries of the ear or brain.

  • Addison's disease.

  • Exposure to toxins and medications that cause damage to the ear.

  • Meniere's disease.

  • Post-traumatic stress disorder.

  • Persistent exposure to loud noises, which damages the cochlea.

  • Tay-Sachs disease.

  • Lyme disease.

  • William's syndrome.

  • Migraines.

  • Autism.

  • Multiple sclerosis.

  • TMJ disorders.

  • Cerebral palsy.

How Is Cochlear Hyperacusis Diagnosed?

An Otolaryngologist or audiologist identifies the type of hyperacusis and severity of the disease.

The following tests help in the diagnosis of cochlear hyperacusis:

1. Loudness Discomfort Level Test:

In this test, the level of loudness that causes discomfort is measured and helps categorize the level of hyperacusis.

The following table depicts the loudness discomfort level and the severity of hyperacusis.


2. Audiogram or Hearing Test:

It is a hearing test that measures the ability of the patient to hear sounds of different pitches and frequencies. With the help of an audiometer, the person's sensitivity to different sound frequencies is measured. However, before performing the hearing test, the loudness and discomfort level of that particular patient must be measured so as not to expose the patient to a higher frequency of sounds.

What Is the Treatment for Cochlear Hyperacusis?

Treatment for cochlear hyperacusis is based chiefly on treating the causes, and there is no medical or surgical treatment, in particular, to treat cochlear hyperacusis.

In the case of cochlear hyperacusis, Tinnitus retraining therapy is the most preferred treatment of choice.

1) Tinnitus Retraining Therapy (TRT):

  • TRT involves two therapies, namely counseling and sound therapy. In tinnitus retraining therapy, the patient is trained to adapt to the excessive sounds caused by hyperacusis. It is a form of habituation-oriented therapy. As a result of this therapy, the patient gets acquainted with the sounds and becomes less reactive to the hyperacusis sounds.
  • Before starting sound therapy, the patient's loudness and discomfort levels are measured. In sound therapy, the sensitivity of the patient to sounds is reduced. As a result, the perspective of how a person views sound is altered, and they tend to take it more positively.
  • In addition to tinnitus retraining therapy, psychological therapies like counseling and cognitive behavior therapies also prove to be helpful in patients with cochlear hyperacusis.

2) Counseling:

It is done to prepare the patient mentally to accept hyperacusis. In this, the patient is explained about the anatomy and physiology of the ear, how sounds are transmitted, and how hyperacusis occurs. Thus, giving an insight into hyperacusis and making the patient free of their fears and problems caused by hyperacusis.

3) Cognitive Behavior Therapy:

Cognitive behavior therapy helps the patient come out of the symptoms of cochlear hyperacusis, change their behavior of avoiding noises, and manage stress caused by loud sounds.

What Lifestyle Changes Help in Cochlear Hyperacusis?

  • Do not try to avoid noisy situations.

  • Avoid using earplugs or muffs all the time. It can increase the severity of hyperacusis by raising the brain's sensitivity to sounds.

  • Do try some relaxation techniques like yoga, deep breathing, etc.

  • Listen to soft sounds and music.

How Can We Prevent Cochlear Hyperacusis?

Hyperacusis can be prevented before its occurrence in the following ways:

  • Avoid exposure to loud noises for an extended period, especially sounds above 85 decibels.

  • While working in places with heavy machinery that produces excessive sounds, wear ear protective aids.

  • Listen to music in earphones only at reduced volume and for lesser periods.


Although not a curable condition, cochlear hyperacusis can be best managed by following adequate measures. First, do not be stressed; instead, try to adapt yourself to these sounds. This can make your life easier. Also, when you experience any discomfort or anxiety, reach out to a healthcare provider and get psychological counseling which can help you come out of the situation.

Dr. Satyabrata Panigrahi
Dr. Satyabrata Panigrahi



cochlear hyperacusishyperacusis
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