Hyperacusis (sound sensitivity) assessment (hyperacusis and decreased sound tolerance assessment)
An assessment for people who find everyday sounds uncomfortably or painfully loud, to understand the type of sound sensitivity, look for any cause, and plan management that gently rebuilds tolerance.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Hyperacusis is when normal everyday sounds feel too loud or painful; it can be mild or seriously disabling.
- Avoiding sound and wearing ear protection for ordinary noise tends to make it worse — the aim is to rebuild tolerance gradually.
- Management uses graded sound therapy, CBT and relaxation, and treats any linked tinnitus or ear problem.
- The assessment is usually not painful; improvement is usually gradual over weeks to months rather than instant.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Explains what type of sound sensitivity you have and what is driving it
An assessment that ends with advice to wear earplugs constantly or avoid sound is the wrong approach and tends to worsen hyperacusis.
You discuss your sound sensitivity, have your ears examined and usually a hearing test, and agree a starting plan.
A clear, written graded sound-therapy plan with realistic goals and a named contact
You discuss your sound sensitivity, have your ears examined and usually a hearing test, and agree a starting plan.
You begin reintroducing everyday sound and cutting back on unnecessary ear protection. This can feel challenging...
With graded sound therapy, the level of sound you can tolerate usually widens and discomfort lessens.
You keep using sound naturally and protect your ears only for genuinely loud noise. Many people regain a normal...
What is a hyperacusis (sound sensitivity) assessment?
Hyperacusis means reduced tolerance to ordinary sound. Everyday noises — rustling paper, cutlery, traffic, children playing — can feel uncomfortably or even painfully loud, even though they are not loud to other people. It can affect one or both ears and ranges from a minor nuisance to something that limits work, social life and going out.
An assessment finds out what your sound sensitivity is really like, checks your hearing, looks for any cause or linked condition (such as tinnitus, migraine, ear problems or, in some people, autism), and sorts out which type of sound difficulty you have. Related but different problems include misophonia (strong emotional reactions to particular trigger sounds) and phonophobia (fear of certain sounds).
A key message runs through good care: avoiding sound and over-using ear protection for ordinary noise usually makes hyperacusis worse over time, because the hearing system becomes even more sensitive. Management therefore gently and gradually reintroduces sound, rather than removing it. Ear protection is still important for genuinely loud noise.
The assessment itself is usually not painful and non-invasive. It cannot, on its own, cure the sensitivity, but it points to the right plan.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Helpful versus unhelpful responses to sound sensitivity
| Response | Short-term effect | Longer-term effect |
|---|---|---|
| Earplugs for ordinary sound | Feels safer and quieter | Tends to increase sensitivity over time |
| Avoiding noisy places | Avoids discomfort now | Shrinks tolerance and daily life |
| Total silence | Feels calmer briefly | Often makes the ears more sensitive |
| Graded sound therapy | Can feel hard at first | Gradually rebuilds tolerance |
Ear protection is still important for genuinely loud noise such as concerts, power tools or motorbikes.
Preparing for your test
- Note which specific sounds are a problem and how they make you feel (too loud, painful, distressing or frightening).
- Note when it started, whether it followed loud-noise exposure or illness, and whether it affects one or both ears.
- Mention any tinnitus, ear pain, fullness, dizziness, migraines or anxiety.
- Bring a list of your medicines.
- Think honestly about how much you are using earplugs or avoiding places, as this shapes the plan.
- Bring details of any autism, sensory-processing or mental-health diagnoses, as these can be relevant.
- Avoid loud-noise exposure just before the appointment so your ears are at their usual baseline.
What happens
An audiologist or specialist will ask in detail about your sound sensitivity, often using a questionnaire to measure its impact, and will examine your ears. You will usually have a hearing test.
They may carefully measure the sound levels at which sounds become uncomfortable for you. This is done gently, with you in control of the volume; it can briefly feel unpleasant but is not harmful. They will also work out whether your difficulty is mainly hyperacusis, misophonia or phonophobia, and whether tinnitus or another ear problem is involved.
You will then agree a management plan. This is usually based on graded sound therapy — slowly and steadily reintroducing everyday sound rather than avoiding it — alongside advice on cutting down unnecessary ear protection, relaxation techniques, and CBT where reactions are strongly emotional. The plan is reviewed and adjusted over time.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- An assessment that ends with advice to wear earplugs constantly or avoid sound is the wrong approach and tends to worsen hyperacusis.
- It is not the right first step if you have sudden hearing loss, which needs same-day medical assessment.
- If the main problem is a specific emotional trigger sound (misophonia) or anxiety, psychological support may be more central than sound therapy alone.
- Programmes promising an instant cure for sound sensitivity are not realistic.
Delay or rearrange if…
- You have sudden hearing loss in the past few weeks — seek urgent medical assessment first.
- You have an active ear infection, discharge or significant ear pain that needs treating.
- You have recently had heavy loud-noise exposure, so your ears are not at their usual baseline.
- You are in crisis or experiencing severe distress that needs urgent mental health support.
Alternatives to discuss
- Self-help and reliable information for mild, non-disabling sensitivity
- Treating an underlying ear problem first
- NHS audiology or tinnitus pathway rather than private care
- Psychological therapy where reactions to sound are strongly emotional
- Migraine or other condition management where that is the main driver
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Explains what type of sound sensitivity you have and what is driving it
- Identifies any linked condition (tinnitus, ear problem, migraine) that can be treated
- Provides a clear, gradual plan to rebuild tolerance to everyday sound
- Helps you stop habits, like over-protecting your ears, that make things worse
- Can reduce distress and allow a return to work, socialising and normal life
- Reassures you when the sensitivity is not a sign of serious disease
Risks & complications
- No quick fix — rebuilding tolerance takes weeks to months and steady effort
- Loudness-discomfort testing and sound therapy can feel uncomfortable at first
- Progress can be uneven, with better and worse days
- Sound sensitivity can feel temporarily worse early in therapy before it improves
- Frustration if you hoped for an instant solution
- The plan needs changing because the first approach does not suit you
- An underlying ear or neurological problem is found that needs separate treatment
- Sound sensitivity is bound up with significant anxiety or low mood needing additional support
The main risk is being given the wrong advice: telling people to wear earplugs all the time or avoid sound feels protective but usually worsens hyperacusis. Good care does the opposite, reintroducing sound gradually. Ask any clinician how their plan will rebuild tolerance, and make sure genuinely loud noise is still being managed sensibly.
Published figures to discuss
Sound-sensitivity assessment is non-invasive and carries essentially no physical risk, so meaningful complication rates do not apply. What varies is how much tolerance can be rebuilt, which depends on the type and severity of sensitivity, any linked conditions, and engagement with graded sound therapy. Outcomes are usually described qualitatively as improved tolerance and reduced distress rather than as fixed success rates.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Physical harm from assessment | Very low | Testing should be adapted so sound exposure is tolerable and stopped if distress is high. | Guide sourcesClinical context |
| Overprotection worsens sensitivity | Recognised management pitfall | Constant earplug use in safe everyday sound can make sound tolerance worse; protection should be reserved for genuinely loud environments. | Guide sourcesClinical context |
| Anxiety, migraine, tinnitus or trauma overlap missed | Common | Hyperacusis often needs a broader assessment than a hearing test alone. | Guide sourcesClinical context |
| Unrealistic promise of a quick cure | Marketing red flag | Improvement usually needs gradual sound desensitisation, counselling strategies and time. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from the assessment. Afterwards, the work is following the graded sound-therapy plan, which gently widens the range of sound you can tolerate over time.
- Some discomfort early in sound therapy that eases as tolerance builds
- Good and bad days, with sensitivity worse when tired or stressed
- A gradual rather than sudden widening of the sounds you can cope with
- Linked tinnitus becoming less intrusive as you stop avoiding sound
- Needing to resist the urge to reach for earplugs in ordinary settings
Aftercare
- Avoid total silence; keep gentle everyday sound around you, including at night.
- Cut down on earplugs and ear defenders for ordinary noise, following your plan.
- Still use proper ear protection for genuinely loud noise such as concerts or power tools.
- Reintroduce sounds gradually and at a level you can manage, building up over time.
- Use relaxation techniques to ease the tension that sound sensitivity can cause.
- Treat any linked tinnitus, ear problem or anxiety alongside.
- Stay in touch with your service and ask for review if you are struggling.
- A list of your specific problem sounds and how they affect you
- A note of when the sensitivity started and any trigger
- List of medicines and any relevant diagnoses (e.g. autism, migraine)
- An honest record of how much ear protection you currently use
- A plan for gentle background sound at home and at night
- Proper ear protection kept for genuinely loud environments
- Contact details for your audiology or sound-sensitivity service
⚠ Get urgent help if…
- Sudden hearing loss alongside the sound sensitivity — seek same-day medical advice
- Ear pain, discharge or a feeling of fullness that does not settle
- New or one-sided tinnitus, or tinnitus that pulses with your heartbeat
- Dizziness, balance problems, facial weakness or numbness
- Rapidly worsening sound sensitivity over days
- Sound sensitivity that is causing severe distress or making you unable to cope
- Any thoughts of harming yourself — get help straight away. Call 999 or go to A&E if you are in immediate danger. For urgent advice, contact your GP, or use NHS 111 in England, Scotland or Wales; in Northern Ireland, contact your GP out-of-hours service or your HSC Trust's Phone First service.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good outcome is that everyday sounds stop feeling painful or threatening and you can take part in normal life again, even if you remain a little more aware of sound than average. This usually develops gradually over weeks to months with graded sound therapy and support.
The assessment can reassure you that the sensitivity is not, in most people, a sign of serious disease, and it points to the right plan. It cannot by itself remove the sensitivity, and no clinician should promise an instant or guaranteed fix.
Many people retain good tolerance once it is rebuilt, but sound sensitivity can flare during stressful periods, illness, or after loud-noise exposure. The coping skills and graded-exposure approach can be used again if needed. Linked conditions such as tinnitus or migraine may need ongoing attention.
Related tests, treatments or support
Sound-sensitivity care is often combined with tinnitus assessment and management, as the two frequently occur together, and with hearing assessment. Where strong emotional reactions to specific sounds (misophonia) or anxiety are prominent, psychological support is offered alongside.
Follow-up & long-term care
You will usually be reviewed to check how the graded sound-therapy plan is working and to adjust it. There is no fixed number of appointments. Report promptly if you develop ear pain, discharge, sudden hearing change, dizziness or rapidly worsening sensitivity.
- Keep everyday sound around you rather than seeking silence
- Resist over-using ear protection for ordinary noise
- Use proper protection for genuinely loud noise to avoid setbacks
- Revisit graded sound therapy if sensitivity flares
- Manage linked tinnitus, migraine or anxiety on an ongoing basis
Repeat, follow-on and what comes next
- The first sound-therapy plan is often adjusted as tolerance changes.
- Sensitivity can flare and the graded approach may need restarting after setbacks.
- Devices and listening levels commonly need fine-tuning.
- Reassessment may be needed if new ear or neurological symptoms appear.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear, written graded sound-therapy plan with realistic goals and a named contact
- Sensible guidance on when to use, and when to avoid, ear protection
- Review appointments to adjust the plan and any devices
- Coordinated care for linked tinnitus, migraine or anxiety
- Clear advice on which symptoms (sudden hearing loss, ear pain, one-sided or pulsatile tinnitus) need prompt medical review
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Length and detail of the assessment and hearing testing
- Whether loudness-discomfort testing and sound-sensitivity questionnaires are done
- Number and type of sound-therapy and CBT sessions
- Whether wearable sound generators or devices are provided
- Number of follow-up and review appointments
- Any treatment of linked tinnitus, ear problems or anxiety
- The clinician's assessment fee and what it includes
- The cost of any hearing test separately
- How many sound-therapy or CBT sessions are included
- The cost of any sound-generating devices
- Follow-up and review arrangements and their cost
- What happens, and what it costs, if further investigation or referral is needed
- The cancellation policy
On the NHS? Sound-sensitivity assessment and therapy are available on the NHS, often via audiology or tinnitus services; private care is mainly used for faster access or particular therapists.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Advising constant ear protection or sound avoidance without explaining it can worsen hyperacusis.
- Promising a quick or guaranteed cure.
- Not distinguishing hyperacusis from misophonia or phonophobia, which need different plans.
- Selling devices without explaining the graded-exposure rationale and alternatives.
- No written plan or clear route back if things get worse.
Marketing red flags
- Claims to 'cure' sound sensitivity quickly or with a single device
- Selling custom earplugs or filters as the main treatment for everyday-sound intolerance
- Advice to avoid all noise, which usually worsens the problem
- Guaranteed results or guaranteed timeframes
- Expensive packages pushed before a proper assessment
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What type of sound sensitivity do I have (hyperacusis, misophonia or phonophobia), and does that change the plan?
- How will your plan gradually rebuild my tolerance to sound?
- How much, and when, should I use ear protection — and when should I not?
- Do I have a hearing loss or tinnitus that also needs treating?
- Realistically, how long might it take to improve, and what does success look like?
- What should I do if my sensitivity suddenly gets worse, or I develop ear pain or hearing loss?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Should I wear earplugs all the time to protect my ears?
Can hyperacusis be cured?
Is the assessment painful?
What is the difference between hyperacusis and misophonia?
Can I get help on the NHS?
Is hyperacusis a sign of a serious problem?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: RNID — Hyperacusis BSA — Practice Guidance: Tinnitus in adults (covers hyperacusis, 2021) NICE NG155 — Tinnitus: assessment and management Hyperacusis Questionnaire validation (PMC) Sound Sensitivity Symptoms Questionnaire (SSSQ2) (PMC) nidirect — urgent and emergency care services (NI) nidirect — GP out-of-hours service (NI)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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