Sound Sensitivity 101: Hyperacusis vs. Misophonia

man blocking his ear from sound sensitivity, hyperacusis, or misophonia

Do certain sounds drive you crazy, or even seem to hurt your ears? Maybe dishes clanking, water running, driving in a car, or the crinkling of plastic? How about your partner’s chewing, or sounds like nails on a chalkboard, or the ticking of a clock? Do any of those trigger your ears to over-react? These sensitivities to normal, everyday sounds may actually be conditions that are grouped together as something called decreased sound tolerance. 

Decreased sound tolerance is how some clinicians in the medical field group together a set of conditions in which a person’s reaction to everyday sounds is hypersensitive when compared to what most people typically experience. These conditions aren’t always defined consistently amongst clinicians and researchers, but rest assured, because this set of negative reactions to sounds is well-recognized by our team of audiologists at Treble Health. 

Learn how Loretta reversed her EXTREME sound sensitivity.

The Two Types of Sound Sensitivity 

The two most common types of sound sensitivity are called misophonia and hyperacusis. Misophonia is when a person has negative emotions or discomfort along with a heightened autonomic nervous system reaction to a specific type of sound. This could be something as simple as someone chewing or the sound of breathing, and the reaction can cause the person to experience irritation, anger, or anxiety. 

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Hyperacusis is when a person experiences discomfort or pain when exposed to certain sounds that are perceived as loud, but are actually an average loudness level. For example, the sound of a car or the sound of dishes clanking together. Hyperacusis can also include negative emotional responses to sounds.

These two types of sound sensitivity can seem to be similar, so an easy way to determine which one that you have is to remember the following – hyperacusis is more of a physical pain, and misophonia is more of an emotional reaction. Since both can cause similar symptoms, working with a specialized audiologist, like our team at Treble Health, can help you accurately diagnose your condition.

Can Earplugs Help With Sound Sensitivity?

For someone without sound sensitivity, it is easy to assume that those with hyperacusis or misophonia simply have sensitive hearing that can be fixed by the use of earplugs. Earplugs are used to reduce the perception of bothersome sounds or avoid them entirely, but this advice assumes that the issue is with the ear itself and that by avoiding sound entirely, the sensitivity will go away. 

However, using earplugs has a high risk of doing more harm than good, and it can actually cause more sound sensitivity issues. People with hyperacusis or misophonia tend to have normal hearing levels, so protection from average-level sounds may prolong the condition unnecessarily. If these common, everyday sounds are avoided, the negative reaction to them can actually be reinforced, potentially causing them to worsen.

If Avoidance Is Not the Answer, What Are The Treatment Options?

There are currently no medical cures for hyperacusis or misophonia, but rest assured that both conditions can be effectively managed by an audiologist specialized in hyperacusis, misophonia, or tinnitus. With a combination of sound therapy and personalized coaching, you can reduce the negative reactions and emotions caused by the troublesome sounds. 

This can be achieved in two ways:

  1. A person can be slowly desensitized to the bothersome sounds by slowly reintroducing the trigger sounds into their daily life.
  2. A person can be given strategies to restructure the negative thoughts and emotions that are triggered by troublesome sounds.

Tinnitus Retraining Therapy

The first strategy mentioned above is achieved through a number of possible methods, such as Tinnitus Retraining Therapy (TRT). For hyperacusis, TRT uses low-level sounds through the environment or sound generators to slowly introduce and expose a person to average-level sounds. When combined with counseling, TRT can help to gradually desensitize the central auditory system to the sounds. This process generally takes between 9 and 18 months to complete, but the timeline is different for every patient. 

TRT can also be used to treat misophonia cases. It first is used to create positive associations with certain sounds, and then trigger sounds are gradually mixed in.

One study done using TRT resulted in 165 of 201 patients (82%) showing significant improvement. Treatment effectiveness was higher for those with misophonia alone (139 of 167, 83%, had positive effects) or both hyperacusis and misophonia together (152 of 184, 83%) than hyperacusis alone (13 of 17 people, 76%). These results are very encouraging.

Some people may be able to work on these gradual sound exposures by themselves, however, it is often difficult to do when the reactions to the sounds are so strong. In these cases, support from a clinician can be very helpful.

Cognitive Behavioral Therapy

Sound-based therapy is not the only option for treatment. Cognitive Behavioral Therapy (CBT) is another option, which can help by reducing reactions to certain sounds. This is done by helping reformulate negative thinking and subsequent actions around sound into more positive thinking and behaviors. 

Another behavioral therapy is Acceptance and Commitment Therapy (ACT). Like CBT and the therapy in TRT, ACT can be helpful in teaching people to cope with distressing reactions. The goal of ACT is to fully accept your feelings towards a situation. Counseling and education that involves people’s families may also be helpful in some cases. 


Another method to reduce negative responses to sound is mindfulness. The practice of mindfulness and its exercises can be used to help someone learn coping skills that can reduce stress and negative emotions. Mindfulness is a type of meditation where the goal is to focus on being intensely in the moment, with awareness of how you’re feeling, both emotionally and physically. 

Misophonia and hyperacusis can have a significant effect on how people are able to function on a daily basis, as many situations can be intolerable. Understanding the difficulties that are being faced and the goals of treatment can help family members and loved ones provide a supportive environment for individuals going through treatment. There are many effective treatment options available, regardless of the type or level of sound sensitivity. If you are experiencing any of the symptoms discussed above, make sure to reach out to a Treble Health audiologist today.

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