Tinnitus and Hyperacusis

The scope of this page includes both tinnitus and hyperacusis in both pediatric and adult populations.

See the Tinnitus Evidence Map for summaries of the available research on this topic.

Hearing-related terminology may vary depending upon context and a range of factors. See the American Speech-Language-Hearing Association (ASHA) resource on hearing-related topics: terminology guidance for more information.

Tinnitus is the perception of sound (e.g., ringing, buzzing, hissing) in the absence of an external sound source. It may be perceived in one or both ears, centered in the head, or localized outside of the head. Objective tinnitus is a rare condition in which the perceived sound is generated within the body—for example, from a muscle spasm or a vascular disorder. Sound from objective tinnitus may be detected/heard by an examiner (i.e., as opposed to being heard only by the individual with the symptom). Subjective tinnitus, which is far more common, is perceived only by the individual with the symptom. As the impact of tinnitus on one’s quality of life can vary (from minimal to severe), there is a difference between bothersome tinnitus and nonbothersome tinnitus. Several other terms are used to differentiate tinnitus within the literature, including the following examples:

  • Primary tinnitus is commonly associated with sensorineural hearing loss.
  • Pulsatile tinnitus is characterized by sound that is rhythmic and resembles the heartbeat.
  • Secondary tinnitus has a specific known cause other than hearing loss.
  • Somatic tinnitus is caused or influenced by sensory input in the body, for example, muscle spasms.

Hyperacusis is a heightened sensitivity to ordinary sounds in the environment that are tolerated well by those without hyperacusis. Hyperacusis may result in a range of reactions to sound, including both physiologic and emotional responses. Categories of hyperacusis include loudness, annoyance, fear, and pain (Tyler, Pienkowski, et al., 2014). As with tinnitus, hyperacusis varies in severity. The negative responses to sound may be strong enough to cause avoidance of routine interactions and situations and may significantly alter a person’s life. Related terms found in descriptions of hyperacusis include the following examples:

  • Decreased sound tolerance refers to various disorders involving intolerance to and avoidance of sound.
  • Misophonia is characterized by a strong dislike of certain sounds (unique to the individual and often repetitive in nature and outside of the listener’s control) that results in negative emotions and reactions.
  • Phonophobia is characterized by a persistent fear of sound.

Tinnitus and hyperacusis may exist independently or in comorbidity.

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