Sound Sensitivity: Understanding and Managing Hyperacusis, Misophonia, and Noise Sensitivity

At our clinic, we use the term sound sensitivity as an umbrella description for a group of conditions in which everyday sounds cause distress. This includes:

  • Hyperacusis – when certain sounds feel too loud or even painful
  • Misophonia – when certain sounds trigger strong negative emotional reactions
  • Noise sensitivity – when noise in general feels disturbing or disruptive, regardless of loudness

Although each of these conditions is different, they can sometimes overlap. For example, you might experience hyperacusis and misophonia together, or have high noise sensitivity along with one of them. Understanding the type of sound sensitivity you have is the first step toward managing it.

Hyperacusis

Hyperacusis means that some everyday sounds are perceived as uncomfortably loud or painful, even when they are at a safe volume. There are three main types:

  1. Loudness hyperacusis – certain sounds (like voices, traffic, music, or hand dryers) feel far too loud. This can also come with sensations such as pressure in the ears, ear fluttering, or popping.
  2. Pain hyperacusis (noxacusis) – even relatively quiet sounds can cause ear pain, such as stabbing, throbbing, or burning sensations. This pain can sometimes spread to the face, head, or neck.
    • It’s important to understand that pain hyperacusis is different from “auditory nociception.” Auditory nociception refers to a pain-like sensation in the ear that results from actual damage to the delicate hair cells or other tissues in the cochlea, usually caused by unsafe levels of noise.
    • According to recent studies, the safe daily noise exposure to avoid tissue damage and prevent noise-induced hearing loss is around 55–60 decibels (A-weighted) — roughly the loudness of a normal conversation.
    • People with pain hyperacusis can feel pain even from short-lasting sounds between 30 and 60 decibels (HL) — levels that are well below the threshold that could cause any damage in the ear.
  3. Fear hyperacusis (phonophobia) – a strong fear or anxiety about certain sounds, either because they are expected to be loud or because you worry they might cause harm or worsen hearing or tinnitus.

Hyperacusis can significantly affect daily life — limiting where you go, what activities you enjoy, and how you feel in noisy environments.

Misophonia

Misophonia is when specific sounds trigger intense feelings of anger, anxiety, disgust, or irritation. These sounds are often repetitive and pattern-based, and they don’t have to be loud to cause distress. Common triggers include:

  • Mouth and nasal sounds – chewing, swallowing, sniffing, breathing
  • Other human sounds – tapping, pen clicking, foot shuffling
  • Environmental sounds – clocks ticking, typing, certain animal noises

Some people also have misokinesia — a similar reaction to certain visual movements, such as leg jiggling or rapid blinking.
Reactions can be physical (tense muscles, faster heartbeat, sweating), emotional (anger, anxiety, disgust), and behavioural (avoiding certain people or places, leaving the room, or mimicking the sound).

In misophonia, once a trigger is noticed, it can be hard to stop focusing on it — which can make the reaction stronger.

Noise Sensitivity

Noise sensitivity is a personality trait rather than a specific disorder. People with high noise sensitivity find many kinds of background noise — like neighbours, traffic, air conditioning, or background music — disruptive, even if the sound is not particularly loud. This is not the same as hyperacusis or misophonia, but it can occur alongside them and increase overall distress.

How Sound Sensitivity Affects Life

Whether it’s hyperacusis, misophonia, noise sensitivity, or a combination, these conditions can:

  • Disrupt work or school performance
  • Strain relationships (especially if triggers involve family or friends)
  • Limit social activities
  • Increase stress, anxiety, or low mood

Avoiding triggers might feel like the safest option, but over time, avoidance can make the problem worse — giving triggers more control over your attention and emotions.

Why Do These Reactions Happen?

Research shows that in sound sensitivity conditions, the brain processes certain sounds differently.
For misophonia, a brain area called the insula appears to be over-connected with regions controlling emotion, movement, hearing, and vision. This means triggers are processed as highly important and emotionally charged, making them difficult to ignore.

For hyperacusis, the brain’s “volume control” can be set too high, so certain sounds are amplified. If those sounds also cause negative emotions such as fear or frustration, this can further increase the sense of loudness and discomfort.

For noise sensitivity, the reaction is more about a general underlying attitude to noise — your brain treats many environmental sounds as unwelcome or intrusive.

Are They Linked to Other Conditions?

Sound sensitivity can exist on its own or alongside other issues such as:

  • Tinnitus
  • Anxiety or depression
  • Autism spectrum disorder
  • Head injury or neurological conditions

Having these other conditions doesn’t guarantee sound sensitivity, but they can sometimes increase its impact.

Can Sound Sensitivity Be Treated?

There is no single “quick fix,” but there are effective treatments to reduce the distress and improve quality of life.
Many methods have been tried — such as sound therapy, exposure therapy, and medication — but the strongest evidence currently supports Cognitive Behavioural Therapy (CBT), particularly when it’s adapted specifically for sound sensitivity.

How CBT Works

At Hashir International Specialist Clinics, we offer a specialised CBT programme developed over more than a decade by Dr Hashir Aazh and colleagues. This programme is designed for misophonia, hyperacusis, and other forms of sound sensitivity, not just general anxiety.

CBT aims to:

  1. Help you understand the condition and how it works
  2. Identify unhelpful thoughts and behaviours that keep the problem going
  3. Break the cycle of distress by introducing new coping skills
  4. Build your confidence in managing triggers

Our therapy is delivered in 14 weekly video sessions and includes:

  • Education about sound sensitivity and CBT
  • Goal setting and personalised strategies
  • Identifying and challenging unhelpful thoughts
  • Reducing avoidance behaviours gradually and safely
  • Learning tools such as SEL (Stop Avoidance, Exposure, Learn) and KKIS (Know, Keep on, Identify, Substitute)
  • Integrating skills into daily life for long-term results

Results From Our Clinic

Our CBT approach is supported by published research. A study conducted at our centre in collaboration with the University of Surrey and the University of Cambridge was published in the American Journal of Audiology in 2024:

“A Preliminary Analysis of the Clinical Effectiveness of Audiologist-Delivered Cognitive Behavioural Therapy Delivered via Video Calls for Rehabilitation of Misophonia, Hyperacusis, and Tinnitus” (Aazh, Najjari, & Moore). Click here to see the full report of the study.

In this study, we reviewed results from 37 patients who received our CBT programme for misophonia, hyperacusis, tinnitus, or a combination. The findings showed significant improvement across all main symptom questionnaires, including:

  • Reduced impact of misophonia, hyperacusis, and tinnitus
  • Lower anxiety and depression scores
  • Increased confidence in managing symptoms

While the study did not include a control group (meaning the results should be interpreted cautiously), the effect sizes were strong — for example, misophonia, hyperacusis, and tinnitus impact scores all improved with medium-to-large clinical effects.

These results reflect what we see in our day-to-day practice: CBT, when delivered in a structured, personalised way by experienced audiologists, can make a real difference.

Click here to see the full report of the study.

Why Choose Us?

  • Specialist expertise – decades of experience in sound sensitivity disorders
  • Tailored care – CBT models built for hyperacusis, misophonia, and noise sensitivity
  • Evidence-based – backed by research and international conference presentations
  • Patient-centred – therapy is adapted to your triggers, goals, and lifestyle

Taking the Next Step

If you find yourself avoiding places, struggling at work or school, or feeling anxious or angry about sounds others barely notice — you are not alone. Sound sensitivity is real, it’s recognised, and it can be managed.

Our goal is to help you take control back from the triggers and live more freely.

Book an appointment today and begin your journey toward a calmer, more confident relationship with sound.