From the perspective of Western medicine, the best current way to treat hyperacusis (once other options have been ruled out depending on its cause) is through auditory desensitization therapies, which retrain the brain not to interpret sounds as loud, annoying, and/or painful when they are not for a healthy person. This treatment works thanks to brain plasticity, that is, the brain’s ability to form new neural networks based on the external stimuli it receives.
There are different approaches to carrying out these therapies, but they are all basically based on the same idea: gradually increasing the volume and exposure time of broadband sounds.
Here, I will detail the treatment I have created. I started from various ideas from existing auditory therapies, and through experimentation, I corrected some things and added others over several years and iterations to arrive at the simplest method that has worked best for me. However, each case has its particularities, and it may be necessary to make some adjustments to suit individual needs. Throughout this article and the rest of the blog, I will provide the foundational knowledge so that, if needed, you can personalize the treatment.
This treatment is appropriate for hyperacusis caused by acoustic trauma, which is the most common cause. Auditory desensitization therapies are also valid for other cases, but depending on the cause, the treatment might be very different. In any case, consult your specialist to determine the best approach for your particular situation.
The principles on which my method for treating hyperacusis is based are the following:
- Continuous control of sound exposure.
- Progressive exposure to sounds that we find intolerable.
- Treatment of the psycho-emotional component.
It is necessary to take the required measures to control the amount of sound we are exposed to in daily life, avoiding both overexposure and overprotection as much as possible. Exposing the ears uncontrollably to more sound than they can tolerate will cause relapses and leave the ears sore and more sensitive. Conversely, overusing silence or hearing protection, or avoiding certain sounds altogether, will prevent adaptation and make our ears more sensitive. In both cases, over time, our sound tolerance threshold will decrease. The goal, therefore, is to avoid both extremes and provide the brain with the best possible sound environment for brain plasticity to take place. Control over exposure is achieved primarily through the use of hearing protection and avoiding sound environments that excessively exceed our tolerance threshold.
This is the main differentiating element of my method compared to other approaches for treating hyperacusis, which often lack specific guidance beyond vague recommendations to avoid very loud noises and not overuse hearing protection. Continuous control of sound exposure allows for faster recovery (sometimes achieving results in just a few days), compared to other approaches such as TRT (Tinnitus Retraining Therapy), where several people report no improvement in the first six months of treatment. Additionally, it prevents many symptoms associated with hyperacusis, such as intense pain, ear fullness, or sound distortion, which can be very difficult to endure. However, its downside is that, especially in severe hyperacusis cases, finding the balance between overprotection and overexposure can be complicated and exhausting, and depending on the sound environment and personal circumstances, it may even be impracticable. In such cases, other therapy methods like PET are recommended.
To recover from hyperacusis, continuous control of sound exposure alone is not enough, as it only prevents worsening. We need something that allows us to restore normal sound tolerance, and this is where sound therapy comes into play. To improve sound tolerance, one must be gradually and carefully exposed to sounds that are uncomfortable or intolerable, whether because their intensity exceeds our tolerance threshold, prolonged exposure fatigues our ears, or their frequency content is harder for us to bear. While continuous sound exposure control provides the optimal environment for brain plasticity to occur, progressive exposure to intolerable sounds provides the proper stimuli for the brain to relearn to listen normally. These are the signals the brain receives, indicating it needs to adapt to those stimuli.
This relearning process is similar to a gymnast improving flexibility to perform, for example, a split. By daily practice—pushing slightly beyond current limits—the exercise can eventually be performed. Forcing beyond one’s current capacity would cause injury and require rest before attempting again. Conversely, ceasing practice would result in the gradual loss of gained flexibility.
Thus, by exposing our ears daily to sounds that may cause some discomfort but are not excessive for the brain, the brain starts to form new neural networks to adapt to these sounds, eventually handling them without pain or other bothersome symptoms.
Although hyperacusis is not a manifestation of a psychological disorder, it can have a psycho-emotional component whose impact, if untreated, could undermine all the progress made through sound therapy. This component relates to any established negative emotional response to sound that developed as a consequence of hyperacusis. Depending on the nature of this response, it may be classified as misophonia or phonophobia.
In mild hyperacusis, where the impact on daily life is lower, the psycho-emotional aspect may not be as decisive. However, in my view, any sound therapy for hyperacusis that ignores this component has a high likelihood of failure. Since most hyperacusis treatments I’ve encountered neglect this point and only provide brief instructions to listen to broad-spectrum sounds, addressing the psycho-emotional component is one of the most important aspects of my method.
How to Treat Hyperacusis
First, I will present what could be called the formula, a brief description of the concrete steps to follow for sound therapy. This section consists of what I call the exposure cycle and the glossary of concepts. The goal is to provide a basic guide that is easy to integrate into our habits and quick to consult in case of doubts about how to proceed.
Secondly, I will provide context and greater depth to what was described in the first section to ensure the concepts are understood.
Finally, I will add a practical example of exactly how to proceed on any given day to further clarify the correct way to carry out the therapy.
- Exposure to the limit until signals to stop exposure are detected or until a defined time ends.
- If the ears are affected, rest with hearing protection until tolerance and tinnitus volume improve (30 minutes – 3 hours).
- Ambient sound and/or comfortable listening. If the ears are affected, perform progressive recovery exposure trying to reach and maintain the optimal stimulation volume (2 – 6 hours).
- Repeat steps 2 and 3 until the ears are stable again.
- Return to step 1 until reaching a tolerance threshold that you consider satisfactory.
- Exposure to the limit: Controlled exposure to sounds that challenge your current tolerance, either due to their intensity or frequency characteristics.
- Stable ears: When, after examining your current tolerance and tinnitus, you are in a condition to expose yourself to the limit again without a clear risk of aggravating your symptoms.
- Affected ears: When the ears were stable but there has been a clear decrease in tolerance, either due to overexposure or negative emotional impact, i.e., a relapse.
- Signals to stop exposure: Stop sound exposure immediately if at least one of the following occurs:
- Localized pain in the inner ear.
- Perception that the sound is too loud.
- Continuous decrease in tolerance.
- Special difficulty tolerating certain sounds or frequencies.
- Noticeable increase in tinnitus with stable ears.
- Negative emotional impact that could reduce tolerance.
- Signals NOT to stop exposure: Do not stop exposure if none of the stop signals are present, even if you experience the following symptoms:
- Mild ear discomfort.
- Discomfort while being exposed to sound.
- High tinnitus with comfortable listening during recovery from a relapse.
- Comfortable listening: Exposure to sounds that do not challenge our ears. The goal is to avoid silence and continue gently stimulating our ears without forcing them to the point of triggering any stop signals.
- Progressive recovery exposure: Comfortable listening starting at the highest volume you find fully comfortable, no matter how low that may be, and gradually increasing it as you see that your tolerance improves. This is crucial for recovering as quickly as possible from a relapse.
- Optimal stimulation volume: The maximum volume that does not trigger any stop signals, even if accompanied by high tinnitus, discomfort, or strange sensations in the ears. It is the optimal volume between overprotection and overexposure that should be targeted during a relapse to avoid stagnation and continue progressing.
- Try to live a normal life
If your hyperacusis is unilateral (or even if bilateral, one ear tolerates sound much better), an excellent way to continue normal activities, even in the presence of sounds that are not well tolerated at the moment, is to protect only the more affected ear with a moldable silicone or foam earplug. This way, you still have the other ear to hear somewhat normally while preventing a relapse.
- Continuously adapt your sound environment to your current tolerance
- Lowering the volume
- Using hearing protection
- Asking people around you to reduce noise
- Continuing your activity in a favorable sound environment
- Suspending the activity you were doing
Do not resist using hearing protection out of embarrassment in front of people who do not understand your condition, or just because you haven’t needed it for a long time.
On the other hand, you should avoid overprotecting yourself from everyday sounds. If your current hyperacusis severity allows it, never stop exposing yourself daily to sounds like traffic, shopping in supermarkets, handling dishes, etc. You should try to do this even during a relapse.
The goal is to avoid both overexposure and overprotection, providing optimal conditions to recover as quickly as possible.
Providing a list of stop-exposure signals alone is not enough. First, a person suddenly experiencing hyperacusis symptoms may not know exactly what it means for tolerance to keep decreasing or how to identify special difficulty tolerating certain frequencies. Second, since hyperacusis varies from person to person, it may be necessary to add new conditions to the list or some may not apply in your case.
The same applies to signals for not stopping exposure. These are physical sensations that are difficult to describe and can differ between individuals. They are especially hard to identify during a relapse when ears are sensitive and unstable, producing all sorts of sensations that naturally feel like a signal to stop exposure to avoid worsening the condition. The challenge is that among these sensations, some must be ignored and should not lead you to stop exposure. Distinguishing between them can be very difficult.
If we don’t know when to stop exposure, we risk overexposure; if we stop when we shouldn’t, we fall into overprotection. Learning to correctly identify these signals has been one of the most challenging and simultaneously crucial parts of the treatment. Therefore, it is essential, through trial and error, to learn to identify these signals correctly to maintain optimal continuous exposure control.
The biological processes that determine the state of our ears are very complex, to the point that ear behavior often seems random. We must try to ignore the underlying logic. Sometimes our ears may feel worse when, based on past experience, we expected them to feel better, and vice versa. Simply respond to the signals your ears give at each moment, even if you cannot understand why. For example, if you receive a signal to stop exposure while listening to a sound you previously tolerated easily, you should stop it even if it doesn’t make sense to you.
- Sound Enrichment
- Music (especially with a wide variety of instruments)
- Nature sounds (ocean waves, rain, rivers, etc.)
- Pink/white/brown noise
The goal of sound enrichment is that listening to a wide range of sounds covering the full auditory spectrum helps and accelerates auditory re-education to recover a tolerance threshold that allows exposure to almost any sound.
Certain sounds, especially high-frequency ones, may be particularly difficult to tolerate. This usually occurs with sounds like white noise, electric guitars, or sounds from small speakers such as mobile phones. It’s fine to temporarily avoid these sounds. However, to regain a normal sound tolerance, you will eventually need to work with these sounds. In general, rather than avoiding or overprotecting against such challenging sounds, you should expose yourself to them in a controlled but repeated manner, day after day, until you can tolerate them normally.
It is preferable to perform comfortable listening and sound enrichment using Hi-Fi speakers, as they can reproduce a wide frequency range and avoid distortion effects that can easily cause relapses. Having a good sound system is recommended but not essential.
If you have tinnitus, broadband sound exposure may temporarily increase tinnitus volume, especially after a relapse. This is normal and should not be a cause for concern. Rest and comfortable listening will return tinnitus to its normal state. As sound tolerance increases, fewer sounds will trigger tinnitus.
In the Downloads section, you can find high-quality noise tracks. For nature sounds, some options include:
- Aire Freshener (free software)
- Natura Sound Therapy
- "Echoes of Nature" CD collection
- Calm Confrontation with Sound
Living with hyperacusis often leads to some degree of misophonia and phonophobia. A negative emotional response to sounds can seriously hinder recovery. The greatest risk is isolation and overprotection, which over time can dramatically lower your tolerance threshold, making recovery much harder. This aspect of treatment must therefore be given special attention.
Be conscious of how you respond to intolerable sounds and the limitations caused by hyperacusis so you can act appropriately. Positive thoughts and emotions create an optimal state for brain plasticity to occur. This article contains more information on how to manage emotional responses to sound.
It is very important to take all necessary measures to avoid worry, anxiety, and stress. Do what works best for you—exercise, hiking, meditation, taking anxiolytics or antidepressants, or consulting a mental health professional if needed.
Seek activities that distract your mind and prevent you from constantly thinking about your ears. Don’t monitor your progress constantly; some days will be better than others. Patience is key. Forgetting about your condition as much as possible will accelerate recovery.
Regarding sound exposure, face sounds prudently but decisively, without fear. This advice is very important. Exposure with concern or fear about worsening is very different from exposure with the determination to tolerate it without problems. Convince yourself that you can improve your tolerance by confronting everyday sounds that are actually harmless.
Relapses
Relapses are the loss of the improvement achieved in sound tolerance. The ears become, almost suddenly, extremely sensitive to sounds that we could tolerate without problems until very recently. Depending on how we respond to them, relapses can last from a few days to several months. They usually occur due to overexposure, although sometimes they can appear without an apparent reason.
Relapses are undoubtedly the factor that most prolongs hyperacusis recovery, as they represent a setback in the progress that then needs to be regained. They are hard to accept because improvement requires significant time and effort, but they must be accepted as part of the recovery process.
Trying to avoid relapses as much as possible speeds up recovery, but it is absolutely impossible to prevent them entirely, since it is not possible to know precisely at all times the exposure duration that will prevent a relapse, not to mention the complete lack of control over external sounds. The goal should be to minimize the number of relapses and ensure that those that occur are as mild as possible.
In my view, during a relapse we do not actually lose the improvement achieved; rather, our ears are temporarily more sensitive. If this weren’t the case, it wouldn’t make much sense that after a relapse our ears end up stronger. What can lead to losing the improvement is when a relapse is very intense and recovery is prolonged, as ear sensitivity will prevent exposure to certain sounds, which ultimately has an effect similar to overprotection.
A relapse, in addition to making the ears sensitive and tinnitus louder, is likely accompanied by various sensations that can alert or scare us, causing us to make wrong decisions. As noted earlier, these physical sensations should be ignored. For example, during a relapse it is very common for tinnitus to be louder. However, if you are performing comfortable listening, it should be ignored, and as you recover from the relapse, tinnitus will return to its usual level.
If after a relapse we lose control and tolerance continues to drop despite following the guidelines, it is probably due to unconscious overexposure of the ears. When this happens, the ears feel fatigued or irritated. In this case, intensive rest through comfortable listening or ambient sound is necessary until the ears are ready to undergo the exposure cycle again. Depending on the degree of fatigue or irritation, this rest may take several weeks.
Example of How to Perform the Treatment
Below is a practical example illustrating how everything explained so far translates into real-life application, helping to understand how to treat hyperacusis according to my method.
You wake up in the morning and your ears are stable. It’s time to go to work, and you take the subway, but the noise of the subway is still too much for your current tolerance level. This is a good moment to expose yourself to the limit and train your brain to tolerate that noise. In general, any sound you can endure for at least 5 seconds is a good candidate for limit exposure. Less than that indicates the sound is well above your tolerance threshold and should be left for later.
If you have been dealing with hyperacusis for a while and have learned how your ears behave and how to identify the signals to stop exposure correctly, you can expose yourself to the subway noise and immediately use ear protection (I recommend moldable silicone or foam earplugs) the moment you detect any of those signals. You still have the whole day ahead, so it’s wise not to take too many risks.
If, on the other hand, you are new to hyperacusis, it’s best to set a short exposure time, for example, 30 seconds. This is just an example; it will depend on your tolerance threshold and how difficult that noise is for you. If you handle it well, you can increase the time slightly the next day. If it was too difficult and left your ears affected, you’ll need to reduce it.
The goal is to expose yourself daily to a sound that challenges your tolerance in a controlled manner, either with a set time or by using the signals to stop exposure. Repeating this controlled exposure, brain plasticity will do its work, and you will notice that you can tolerate the sound longer each time until you eventually handle it indefinitely without focusing on it.
Once you arrive at the office, the deafening subway noise is gone. If limit exposure left your ears somewhat affected, you may need to rest with ear protection until you feel better. But at the office, you must be able to talk to your colleagues, so you cannot keep both ears blocked. You have the option to cover only your weaker ear or wear both plugs but leave the stronger ear partially open to hear sufficiently well.
In general, resting with ear protection for more than 3–4 hours doesn’t help. Remember, hyperacusis is treated with sound, not silence. Rest can relieve symptoms temporarily, but after that, exposure to sound is necessary to keep increasing tolerance.
Once rested (or if rest wasn’t needed because limit exposure didn’t affect your ears), it’s time for ambient sound and comfortable listening. Two things may happen: either the office noise and conversations are no challenge for your ears (so you can continue without worry), or at certain moments, situations exceed your comfort level and could cause a relapse if unprotected—for example, dealing with a loud colleague or eating in a crowded space. In these cases, apply continuous exposure control: regardless of the exposure cycle stage or current activity, if a sound may affect your ears, protect them. If it’s momentary, covering the ear with your finger may suffice. If it’s prolonged, use the earplug until the danger passes.
After at least two hours of ambient sound/comfortable listening, assess your ears. If stable, you can repeat the exposure cycle and expose yourself to the limit again, perhaps finding moments during work similar to the subway example. If not, congratulations—that indicates a good tolerance level.
At home, your environment should be optimal for therapy: ears can rest as needed, you have greater control over exposure, and your Hi-Fi system allows further training. During a relapse, progressive recovery exposure is most effective. But for optimal conditions, a controlled environment is necessary, since it’s hard to manage in uncontrolled settings with unexpected sounds. Discipline in continuous exposure control is crucial when away from your controlled environment.
If certain music styles or volumes are difficult, or you can only tolerate them for a short time, it indicates further tolerance work is needed. If your ears are stable, expose yourself again to the limit and repeat the cycle. In a controlled environment, you can take more risks because it’s safe. Suppose limit exposure leaves your ears significantly affected. Maybe you misidentified stop signals, overexposed, or even did everything correctly but a relapse occurred. Whatever the reason, learn from errors without being harsh on yourself. Hyperacusis is challenging, and willpower, patience, and mood vary.
Rest until you feel better. Depending on severity and home noise level, protective rest may not be needed. Then, perform progressive recovery exposure at the optimal stimulation volume. Experience shows this is the fastest way to overcome a relapse. For me, watching movies or series works best—they distract the mind, help manage frustration, and contain varied sounds with breaks, stimulating the full frequency spectrum without fatigue. Other engaging activities are also valid.
Set the volume at the highest comfortable level. Comfort doesn’t mean absence of sensitive ears, pain, or loud tinnitus—these are normal during a relapse and should be ignored. The key is not forcing your ears further, which would worsen the relapse.
Don’t worry if the volume must be very low. If dialogue is unclear, use subtitles or choose another activity with tolerable background sound. Gradually increase volume as tolerance improves until it reaches normal levels. If 6 hours pass without reaching it, at least aim for the optimal stimulation volume. Identifying this volume takes experience and familiarity with your ears. Essentially, it’s the highest volume that doesn’t overstress your ears.
If all goes well, your ears stabilize in under 6 hours. If not, continue resting, comfortable listening, and continuous exposure control until stable. Using this method, I typically recovered from a relapse in under 24 hours—sometimes just hours, sometimes a week. Times vary individually.
While at home, perform daily tasks without protective overuse. If exposure doesn’t worsen tolerance, avoid unnecessary protection during a relapse. Overprotecting essential activities complicates recovery.
At bedtime, unlike some hyperacusis methods, I don’t recommend sleeping with sound. My method relies on continuous exposure control, and you can’t detect stop signals while asleep. Low-volume water or fan sounds are fine if tolerated. Sleep allows ears to rest and prepare for the next day.
The next day, returning to the office, suppose your ears are still affected. Avoid limit exposure on the subway for now—reduce exposure until ears stabilize. Office noise may also be excessive; use plugs if needed for the workday. Take short breaks without plugs to expose ears gradually.
Eventually, ears stabilize, and the full exposure cycle can resume. Repeat until you can live normally without worrying about sounds. Always carry earplugs for unpredictable situations, though eventually, you’ll hardly need them.
This example illustrates specific cases that may differ based on hyperacusis severity or personal circumstances. It’s meant to clarify key concepts and how my treatment method should be applied. Each person should adapt it to their situation for effective use.
Common Mistakes
- Overprotection. This is perhaps the most common mistake, already mentioned earlier. Some sounds bother us, trigger a relapse, and make us lose hard-won progress. Our ears hurt, and silence seems to relieve the pain. Almost unconsciously, we start using ear protection indiscriminately. Continuously avoiding a certain sound intensity makes us more sensitive to that sound. Overprotection can worsen hyperacusis almost as much as overexposure. Remember, overprotection can also occur without using ear protection, simply by staying too long in excessively quiet environments.
- Overexposure. Sounds above our tolerance level can aggravate hyperacusis, so it’s essential to protect ourselves with ear protection or avoid those sounds. We shouldn’t stop listening to bothersome sounds entirely, but we must protect ourselves from sounds that cause pain. Overexposure can also occur during comfortable listening at first, if long exposure eventually triggers stop signals. Finding a balance between protection and exposure is often difficult but crucial to reducing recovery time.
- Confusing discomfort with pain or doing something wrong. Pain is the body’s signal that something is wrong and requires corrective action. During auditory retraining, it’s normal to feel some discomfort, which can be mistaken for pain or warning signals, leading to incorrect measures such as further avoiding sound. This is especially true for people with severe hyperacusis, as discomfort can be frightening, but it’s normal and will disappear as sound tolerance improves. Early confusion is expected until you learn to differentiate between discomfort and actual pain.
- Underestimating fear and anxiety. Naturally, the longer someone has hyperacusis, the more relapses they have experienced, and the more severe the condition, the greater the fear of sounds and anxiety. Misophonia or phonophobia can develop. Fear can make harmless sounds seem unbearably loud and even trigger a relapse. It’s not always obvious that hypersensitivity has developed, as extreme caution with sounds seems natural to avoid relapse or pain. However, this attitude is more harmful than it seems. Fear and anxiety hinder or even block recovery, so it’s critical to address this. Confront sounds without fear, though with caution, and avoid negative reactions to bothersome sounds. Positive thoughts and a relaxed, cheerful mood facilitate brain plasticity, while negative emotions, worry, or sadness impede or block it.
- Stopping therapy until discomfort or pain disappears. After overexposure, rest may be necessary to allow ears to recover, but after 3–4 hours of silence, sound exposure should resume. Waiting for discomfort or pain to vanish completely before continuing therapy is a mistake, as these sensations likely won’t disappear until hyperacusis improves. Hyperacusis improves with sound, not silence.
- Impatience. Recovery from hyperacusis is a long process requiring patience and consistency. Trying to speed it up usually leads to repeated relapses, achieving the opposite of the intended result.
Tips
- Avoid exposure to loud sounds. Remember that the potential harm of a sound depends on three factors: its intensity, the duration of exposure, and the sound frequencies. We often focus only on intensity, which is a mistake. Even moderate volume over long exposure can cause damage. Sounds above 85 dB can cause irreversible damage to the inner ear (first the outer hair cells, then the inner cells, and finally the nerve fibers and the Corti ganglion). Safe exposure time ranges from 8 hours at 85 dB to 8 seconds at 121 dB, halving for every 3 dB increase. Rock concerts can reach 110–140 dB. If exposure is unavoidable, use proper ear protection. Sounds below 85 dB are safe in terms of irreversible inner ear damage, but those above your UCL (uncomfortable loudness level) can worsen hyperacusis. This “damage” is reversible, and sound tolerance can be recovered.
- Be cautious with headphones. Unlike other approaches, I do not recommend using headphones to treat hyperacusis. Open listening with Hi-Fi speakers is preferable. Headphones make it harder to notice if the sound is too loud and to identify stop signals. However, using headphones is part of recovery and should be included in therapy. During a relapse, avoid headphones until ears are stable. Always ensure volume is not too high and exposure time does not exceed 1 hour consecutively.
- Avoid wearing earplugs for many hours every day. Excessive use of ear protection can cause ear pain, especially with plugs that completely block the ear canal. In very noisy environments, it’s better to wear plugs for hours than risk a relapse. Solutions include taking short periodic breaks, partially removing plugs to allow some sound in, or using over-ear protective headphones.
- Listening to compressed music. This article discusses this in detail.
- Use sleep to let your ears rest. Some specialists suggest exposure to sound while sleeping to continue stimulation. While logical, it’s hard to control exposure while asleep, so it’s better to let ears rest after a full day of training rather than risk starting a new day fatigued and sensitive. If necessary to avoid overexposure from environmental noise, sleeping with earplugs is preferable.
- Be cautious outside your controlled environment. When outside your controlled, familiar environment (like home), take extra care with exposure to avoid relapses where progressive recovery exposure cannot be optimally performed.
Other options for treating hyperacusis with sound therapy:
Last updated: 16/08/2025
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