Severe Hyperacusis and Reactive Tinnitus: How to Treat & Cope?

[mandyc]

Just wondering how best to treat hyperacusis. I've had it quite severely for about five months now, along with bad reactive tinnitus. The tinnitus is very loud and I'm struggling to sleep. I'm scared to take medications in case they make things worse.

I've had all the tests from ENT and audiology, and nothing is wrong. No hearing loss. I'm wondering if I should start exposure therapy to deal with the hyperacusis or if I should hold off and rest my ears for a few more months.

My tinnitus started suddenly overnight in one ear and then progressed to the other. After five months, it is fluctuating between ears. I take a Zopiclone once a week, which gives me about three or four hours of sleep, but I still struggle to fall asleep and stay asleep since this began. Whether I get sleep or not doesn't seem to affect the tinnitus. In fact, some days when I haven't slept at all, the tinnitus is a bit better—maybe because my brain is too exhausted to produce the sound?

I don't want to make the hyperacusis worse, and I worry that exposure therapy might do that, leaving me with no way back. I'm wondering what other people have done.

I'm not wearing earplugs around the house, but I can't stay in the kitchen when the kettle is boiling or the washing machine is running. Even the fridge sound is loud and irritating. I can't stand running water, and the wind is often strong here, so I can only get outside in the garden on still days. Going in a car is impossible because of the sound of the tyres on the road.

I usually start the morning with barely any tinnitus at all, but it comes on around 11 a.m. and gets worse as the day goes on. Any advice from anyone who has been through this or is going through it now?

 

[MindOverMatter]

I'm not wearing earplugs around the house, but I can't stay in the kitchen when the kettle is boiling or the washing machine is running. Even the fridge sound is loud and irritating. I can't stand running water, and the wind is often strong here, so I can only get outside in the garden on still days. Going in a car is impossible because of the sound of the tyres on the road.

I usually start the morning with barely any tinnitus at all, but it comes on around 11 a.m. and gets worse as the day goes on. Any advice from anyone who has been through this or is going through it now?

Luckily, or unfortunately, five months is still a very short time for this kind of sound sensitivity and reactive tinnitus.

There is plenty of time for you to improve. What will work best for you is almost impossible to know for sure, since this is very much a trial-and-error process.

Personally, I have been to hell and back with this, but I am in a much better place now than I was in 2019 when I first experienced a major worsening. Luckily, I sought professional help early on and was fortunate to get counseling from an audiologist after a few months, someone who specialized in tinnitus, hyperacusis, and CBT.

It probably took me at least a year before I could see real changes in how I responded. The tinnitus was by no means gone, but my negative emotions toward it became less intense with acceptance, counseling, and time.

I am not here to tell anyone to simply push through, but I chose not to give up my life. I stopped going to the obviously loud events such as concerts, cinemas, and clubs, but I still went to weddings, birthday parties, and restaurants. I kept working full time, driving, exercising, traveling, and so on, even during the most difficult period of my life.

Nothing is impossible, but I will not deny that it was hard. I did all of these things with some level of ear protection, despite the constant cacophony in my head. For me, the alternative—total isolation—would have been worse. Staying engaged with life helped keep me sane and prevented me from spiraling into a deeper depression.

I reacted to almost everything you mentioned, and more: road noise, wind, voices, running water, rain, frying, kettles, air conditioning. Pretty much everything triggered me at one point.

Still, I kept going. I was careful not to overdo it, and I stepped back when necessary. I rested a lot in between and spent much of my time hiking, being physically active, practicing photography, and staying in nature. That was my healer. Although natural sounds were overwhelming at first, they eventually gave back more than they took. Nature helped me rewire my brain because I wasn't exposed to harmful levels of artificial noise. It calmed my mind and body once I allowed myself to "lower my guard" and accept the reactions. Over time, the emotional charge attached to the sounds faded.

Slowly, things improved. At first I might get only one good day, followed by two or three difficult ones. It was a rollercoaster, non-linear. But as the months went by, the good days became more frequent. It's hard to remember the exact timeline now, but I can see the bigger picture.

Spikes and setbacks will happen. They are unavoidable, and progress is hard to measure. This is not something you can evaluate day by day or even week by week—you need to look at it over longer periods.

In these six years, I have had many moments where I thought I was back to square one after a setback: an MRI, fireworks, a grinding machine, or something else unexpected. There has been a lot, but I survived it all. And the truth is, I was never really back at square one. Even when a setback lasted close to six months, progress eventually returned.

I have noticed that the less tense I become in soundscapes that once caused huge problems, the less spiking there is, if any. It is all connected.

I could probably write a whole book about this.

As for what you should do—only you will know in time. My advice is to go slow and steady. Stay active, but don't overdo it. As you gain confidence, you can gradually do more. It is not impossible to drive again. I know what you mean, but you will get there. Give it a couple of months and start small. Use proper custom musician's earplugs in the car for six to twelve months, and use them when you feel you need them. Choose the filter that feels right for you, but don't overprotect.

 

[RunningMan]

Just wondering how best to treat hyperacusis. I've had it quite severely for about five months now, along with bad reactive tinnitus. The tinnitus is very loud and I'm struggling to sleep. I'm scared to take medications in case they make things worse.

I've had all the tests from ENT and/reactive-tinnitus-hyperacusis-aaudiology, and nothing is wrong. No hearing loss. I'm wondering if I should start exposure therapy to deal with the hyperacusis or if I should hold off and rest my ears for a few more months.

My tinnitus started suddenly overnight in one ear and then progressed to the other. After five months, it is fluctuating between ears. I take a Zopiclone once a week, which gives me about three or four hours of sleep, but I still struggle to fall asleep and stay asleep since this began. Whether I get sleep or not doesn't seem to affect the tinnitus. In fact, some days when I haven't slept at all, the tinnitus is a bit better—maybe because my brain is too exhausted to produce the sound?

I don't want to make the hyperacusis worse, and I worry that exposure therapy might do that, leaving me with no way back. I'm wondering what other people have done.

I'm not wearing earplugs around the house, but I can't stay in the kitchen when the kettle is boiling or the washing machine is running. Even the fridge sound is loud and irritating. I can't stand running water, and the wind is often strong here, so I can only get outside in the garden on still days. Going in a car is impossible because of the sound of the tyres on the road.

I usually start the morning with barely any tinnitus at all, but it comes on around 11 a.m. and gets worse as the day goes on. Any advice from anyone who has been through this or is going through it now?

Be careful about exposure so that you don't become permanently worsened. See this post:

Reactive Tinnitus, Hyperacusis, and Noxacusis: Staying Below Sound Tolerance Is Key

Here is an excellent description of my tinnitus symptoms, which I found on the Reddit tinnitus forum. It perfectly captures how severe these symptoms are and how they affect my life: If someone has reactive tinnitus, hyperacusis, and noxacusis but is never in an environment quiet enough to fall...

www.tinnitustalk.com

 

[hubast]

I'm going through the same thing right now. Mine started on October 18th, 2025.

Luckily, or unfortunately, five months is still a very short time for this kind of sound sensitivity and reactive tinnitus.

There is plenty of time for you to improve. What will work best for you is almost impossible to know for sure, since this is very much a trial-and-error process.

Personally, I have been to hell and back with this, but I am in a much better place now than I was in 2019 when I first experienced a major worsening. Luckily, I sought professional help early on and was fortunate to get counseling from an audiologist after a few months, someone who specialized in tinnitus, hyperacusis, and CBT.

It probably took me at least a year before I could see real changes in how I responded. The tinnitus was by no means gone, but my negative emotions toward it became less intense with acceptance, counseling, and time.

I am not here to tell anyone to simply push through, but I chose not to give up my life. I stopped going to the obviously loud events such as concerts, cinemas, and clubs, but I still went to weddings, birthday parties, and restaurants. I kept working full time, driving, exercising, traveling, and so on, even during the most difficult period of my life.

Nothing is impossible, but I will not deny that it was hard. I did all of these things with some level of ear protection, despite the constant cacophony in my head. For me, the alternative—total isolation—would have been worse. Staying engaged with life helped keep me sane and prevented me from spiraling into a deeper depression.

I reacted to almost everything you mentioned, and more: road noise, wind, voices, running water, rain, frying, kettles, air conditioning. Pretty much everything triggered me at one point.

Still, I kept going. I was careful not to overdo it, and I stepped back when necessary. I rested a lot in between and spent much of my time hiking, being physically active, practicing photography, and staying in nature. That was my healer. Although natural sounds were overwhelming at first, they eventually gave back more than they took. Nature helped me rewire my brain because I wasn't exposed to harmful levels of artificial noise. It calmed my mind and body once I allowed myself to "lower my guard" and accept the reactions. Over time, the emotional charge attached to the sounds faded.

Slowly, things improved. At first I might get only one good day, followed by two or three difficult ones. It was a rollercoaster, non-linear. But as the months went by, the good days became more frequent. It's hard to remember the exact timeline now, but I can see the bigger picture.

Spikes and setbacks will happen. They are unavoidable, and progress is hard to measure. This is not something you can evaluate day by day or even week by week—you need to look at it over longer periods.

In these six years, I have had many moments where I thought I was back to square one after a setback: an MRI, fireworks, a grinding machine, or something else unexpected. There has been a lot, but I survived it all. And the truth is, I was never really back at square one. Even when a setback lasted close to six months, progress eventually returned.

I have noticed that the less tense I become in soundscapes that once caused huge problems, the less spiking there is, if any. It is all connected.

I could probably write a whole book about this.

As for what you should do—only you will know in time. My advice is to go slow and steady. Stay active, but don't overdo it. As you gain confidence, you can gradually do more. It is not impossible to drive again. I know what you mean, but you will get there. Give it a couple of months and start small. Use proper custom musician's earplugs in the car for six to twelve months, and use them when you feel you need them. Choose the filter that feels right for you, but don't overprotect.

Do you know what machine they used on you for the MRI? They want to do the standard MRI to rule out a tumor on the auditory nerve. How long did your setback last?

My tinnitus began after an extreme acoustic trauma. Someone pushed a button while my ear was right next to a speaker, and it blasted at about 150 dB only two inches from my ear.

 

[MindOverMatter]

Do you know what machine they used on you for the MRI? They want to do the standard MRI to rule out a tumor on the auditory nerve. How long did your setback last?

My tinnitus began after an extreme acoustic trauma. Someone pushed a button while my ear was right next to a speaker, and it blasted at about 150 dB only two inches from my ear.

It has been quite some time since I had my last MRI, but the setbacks afterward never lasted more than about six weeks with proper ear protection, if I remember correctly.

I actually recommend taking a small dose of Diazepam before the MRI to calm yourself. That helped me a lot. Make sure you have someone drive you both ways.

I usually do not use medication like this at all, but in this situation it was very helpful for me.

 

[hubast]

It has been quite some time since I had my last MRI, but the setbacks afterward never lasted more than about six weeks with proper ear protection, if I remember correctly.

I actually recommend taking a small dose of Diazepam before the MRI to calm yourself. That helped me a lot. Make sure you have someone drive you both ways.

I usually do not use medication like this at all, but in this situation it was very helpful for me.

Thank you so much for the kind advice. I really appreciate it. What did you experience during the six weeks after the MRI?

 

[MindOverMatter]

Thank you so much for the kind advice. I really appreciate it. What did you experience during the six weeks after the MRI?

Honestly, I do not recall many details. I only remember having a more sensitive auditory system with more reactiveness.

It was almost just as bad before the MRI, simply because of the increased anxiety, as it was afterward. The fear of the unknown and not knowing what is coming can elevate your tinnitus on its own because of the amount of stress you build up.

 

[Paulie87]

Has a consensus been reached on whether hyperacusis and reactive tinnitus are actually related? I get zero pain or discomfort from loud noise, but my tinnitus reacts like crazy and often competes or changes to a higher, louder pitch with fan type noises, such as the ones from the air purifiers we own when they ramp up speed.

I also have what I assume is dysacusis, since some high-pitched sounds have a sharp metallic edge.

I would be willing to try Clomipramine if it helps reactive tinnitus, but it seems pointless for me if it only helps hyperacusis. I am happy for all of you with actual hyperacusis who get relief.

I am really praying that the Susan Shore device comes through, since I have what feels like the most classic case of somatic tinnitus there is. Every neck, jaw, or back movement triggers it up or down. I went to a physiotherapist today, and he found tension in my back and neck that I did not even know about. He would press, and the tinnitus would go up or down. Just crazy.

It was almost just as bad before the MRI, simply because of the increased anxiety, as it was afterward. The fear of the unknown and not knowing what is coming can elevate your tinnitus on its own because of the amount of stress you build up.

This was unfortunately my experience before the Oasis concert I attended just under 2 weeks ago. I was nervous about it, and wore my Loops earplugs. I had my watch and phone monitoring sound levels, and even before the gig my tinnitus spiked. Afterwards my tinnitus was fine, but then I came on here and Reddit, started reading horror stories about how I should not have gone at all, and 4 days later I was a wreck with increasing tinnitus and reactivity again, which is what happened the last time I was this stressed out.

I did everything properly at this gig. I only had 2 drinks, never took the plugs out even when I wanted to hear the crowd more, and pushed them in further if I felt them move when I was singing. I even used the optional Loops foam tips for a better seal. Outside of not going, I do not know what else I could have done, and yet I feel miserable for trying to enjoy the one thing that always made me happier than anything: live music.

I have read things on here that turned out to be flat-out false, such as bone conduction being an issue at regular concerts even with earplugs. This is not backed by any science or by asking ChatGPT or Grok. A regular 100 to 110 dB rock concert will allow about 60 to 70 dB through bone conduction, which is simply not enough for the average person to get a severe increase.

 

[MindOverMatter]

Has a consensus been reached on whether hyperacusis and reactive tinnitus are actually related? I get zero pain or discomfort from loud noise, but my tinnitus reacts like crazy and often competes or changes to a higher, louder pitch with fan type noises, such as the ones from the air purifiers we own when they ramp up speed.

Yes, sort of. They are related in one way or another. I do not get sudden discomfort or pain from loud noise either, only if I have had a flare in tense jaw or TMD issues.

About concerts and similar events, unfortunately I can only tell you one thing: stay away.

It is a gamble with very high stakes, and you probably will not win given your circumstances right now. It is not worth it. Maybe sometime in the future, but for now, no. Your auditory and nervous system is too fragile.

 

[Nick47]

Has a consensus been reached on whether hyperacusis and reactive tinnitus are actually related? I get zero pain or discomfort from loud noise, but my tinnitus reacts like crazy and often competes or changes to a higher, louder pitch with fan type noises, such as the ones from the air purifiers we own when they ramp up speed.

Hi @Paulie87, I have read your story. You have noise-induced tinnitus and possibly low-level Ménière's disease.

After having hyperacusis many years ago, you are now always susceptible to these setbacks. Your setbacks come from prolonged loud noise. I am in a setback now, and in 2024 I had one that lasted six months. I wore earplugs and spent three hours in bars. You really must avoid pubs, bars, cinemas, planes, concerts, and similar places for a while, at least until there are treatments.

As for whether hyperacusis is involved in reactive tinnitus, the medical professionals are still clueless, unfortunately. When my hyperacusis flares after a setback, my tinnitus becomes more reactive. I do get loudness hyperacusis.

As for ChatGPT, half the time it gives nonsense. If you want to read the debate about reactive tinnitus, Neuromed has an article about it. It is very speculative though. You already know what caused yours, if that gives you any comfort.

When mine becomes severe and I cannot take it anymore, I take Clonazepam for a day or two.