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Classification according to ICD-10
H93.2 Other abnormal hearing sensations, including hyperacusis
ICD-10 online (WHO version 2019)

Under hyperacusis ( Greek hyper , over ', Akuo , I hear') refers to an abnormal hypersensitivity to sound , which is usually not perceived as unpleasantly loud. Hearing that is perceived as painful is referred to as hyperacusis dolorosa .

Hyperacusis should not be confused with hypacusis or hypoacusis , the hearing loss .


Hyperacusis can appear as a symptom of another condition. If the underlying disease is successfully treated, the hyperacusis usually also recedes. Such intolerance to loud sound is regularly found in the hearing impaired with hair cell damage in the inner ear . Such hard of hearing people cannot hear quieter sound, but once the hearing threshold is exceeded , the perception of loudness increases with the sound level much more quickly than with people with normal hearing, so that at higher levels the sound is perceived as uncomfortable or even unbearably loud. This phenomenon is known as recruitment (excessive increase in loudness).

The overwhelming number of sensorineural hearing loss sufferers from recruitment and therefore suffer from a more or less pronounced intolerance to loud sound. This recruitment symptom is often referred to as hyperacusis. When supplying hearing aids to the hard of hearing with recruitment, technical measures prevent excessively loud sound from being emitted into the ear. Other underlying diseases can e.g. As Meniere's disease , cochlear hydrops , superior canal dehiscence , craniocerebral trauma , Lyme infection , post-traumatic stress disorder , depression , mania or migraines be.


Hyperacusis can arise from the same cause as and at the same time as other diseases. She occurs z. B. often at the same time or at different times with tinnitus . Hyperacusis can also appear as an independent disease. It differs from recruitment in that the pathological sensitivity to loud sound occurs despite the presence of a normal or approximately normal hearing threshold. Patients often perceive even low volume noises as unbearably loud. Another form of hyperacusis is phonophobia, in which only certain, negatively charged noises are perceived as unpleasant or unbearably loud, while this is not the case with other noises, even if their volume is higher. Such a situation arises, for example, when the mere ringing of a telephone is perceived as unbearably loud.

A special case of hyperacusis arises from the failure of the stapedius reflex due to facial paralysis . With such a paralysis, the reflex path - the stapedius nerve - of the reflex that serves to dampen loud sound in the middle ear is also interrupted. In the case of, as is usually the case, only one-sided paralysis, the hyperacusis only occurs on the paralyzed side. A similar situation arises after an operation for otosclerosis , since the stapes are replaced by a prosthesis and the stapedius muscle is therefore no longer effective.


Discomfort threshold audiogram (US test) : group data from patients with hyperacusis but without hearing loss. Upper line: average hearing thresholds. Lower long line: US of this group. Lower short line: US of a comparison group with normal hearing.

Similar to a normal hearing test, a discomfort threshold audiogram is created. This is used to check for hypersensitivity ( intolerance ) to loud sound across the usual spectrum of acoustic frequencies in a hearing test. In hydrops and Menière patients, such hypersensitivity usually precedes the subsequent hearing loss. Therefore, for reasons early detection and prevention ( prevention ) of this fairly simple special test strongly recommended already at the first sign of hypersensitivity to loud sound. Depending on the results and the comparison with the data of the normal hearing test, advice can then be given about measures or further examinations.


Hyperacusis as an independent disease (possibly after a symptom has become independent or as a co-disease) can, depending on the cause, possibly be treated with tinnitus retraining therapy or behavioral therapy or sufficient acoustic and psychological rest. The success rates and the extent of therapeutic success, for example staggered according to patient groups, are not certain. Behavioral or other psychotherapy can serve both to treat a causally psychologically conditioned hyperacusis and to help with other causes in dealing with symptoms and noise-stress or noise-causing noises and their causes. There can also be interactions with other mental illnesses or weaknesses and can be recognized and treated in this way.

The treatment of hyperacusis suffers from a lack of systematic research. In addition, the existing knowledge is insufficiently communicated to doctors, therapists and patients. Individual therapy methods are often set absolutely in publications, thus denying patients access to other explanatory models and therapy options. There is no standardized diagnostic procedure. Even the name of the disease is inconsistent. Often there is uncertainty about the responsible specialist or there is a lack of interdisciplinary knowledge. Existing diagnostics, e.g. B. Questionnaires developed by psychosomatists seem to be largely unknown. Referrals to other specialists, e.g. B. Psychiatrists, may not be associated with the required explanation and can lead to non-acceptance and so on. U. lead to unsuccessful treatment.


  • RS Tyler, M. Pienkowski, ER Roncancio, HJ Jun, T. Brozoski, N. Dauman, N. Dauman, G. Andersson, AJ Keiner, AT Cacace, N. Martin, BC Moore: A review of hyperacusis and future directions: part I. Definitions and manifestations. In: American journal of audiology. Volume 23, Number 4, December 2014, pp. 402–419, doi : 10.1044 / 2014_AJA-14-0010 , PMID 25104073 (Review), semanticscholar.org (PDF)
  • M. Pienkowski, RS Tyler, ER Roncancio, HJ Jun, T. Brozoski, N. Dauman, CB Coelho, G. Andersson, AJ Keiner, AT Cacace, N. Martin, BC Moore: A review of hyperacusis and future directions: part II. Measurement, mechanisms, and treatment. In: American journal of audiology. Volume 23, Number 4, December 2014, pp. 420–436, doi : 10.1044 / 2014_AJA-13-0037 , PMID 25478787 (Review), semanticscholar.org (PDF)
  • DM Baguley: Hyperacusis. In: Journal of the Royal Society of Medicine. Volume 96, Number 12, December 2003, pp. 582-585, ISSN  0141-0768 . PMID 14645606 . PMC 539655 (free full text). (Review).
  • Hyperacusis . In: Roche Lexicon Medicine . 5th edition. Urban & Fischer, 2003, ISBN 3-437-15150-9 .
  • H. Schaaf, B. Klofat, G. Hesse: Hyperacusis, Phonophobia and Recruitment . In: ENT practice . tape 51 , 2003, ISSN  0017-6192 , p. 1005-1011 , doi : 10.1007 / s00106-003-0967-y .
  • M. Nelting (Ed.): Hyperacusis: recognize early, treat actively . Thieme, Stuttgart 2003, ISBN 3-13-129181-8 .

Web links

Individual evidence

  1. cf. ICD-10 , Diagnostic Criteria for Research and Practice, Chapter V (F), 4th Edition 2006, F30.1, Criterion C
  2. J. Sheldrake, PU Diehl, R. Schaette: Audiometric characteristics of hyperacusis patients. In: Frontiers in neurology. Volume 6, 2015, p. 105, doi: 10.3389 / fneur.2015.00105 , PMID 26029161 , PMC 4432660 (free full text).
  3. ^ CS Hallpike, JD Hood: Observations upon the neurological mechanism of the loudness recruitment phenomenon. In: Acta oto-laryngologica. Volume 50, 1959 Nov-Dec, ISSN  0001-6489 , pp. 472-486, PMID 14399131 .
  4. H. Levo, E. Kentala, J. Rasku, I. Pyykkö: Aural fullness in Menière's disease. In: Audiology & neuro-otology. Volume 19, number 6, 2014, ISSN  1421-9700 , pp. 395-399, doi: 10.1159 / 000363211 , PMID 25500936 .