Tinnitus is a persistent ringing or buzzing in your ear that doesn’t have an external source. Hyperacusis is a hearing disorder that causes an oversensitivity to sound.

Tinnitus and hyperacusis often occur together, and the reason why they develop is poorly understood. The severity of each can range from mild to extremely disruptive to daily living.

Experts have theorized that these conditions may be associated with problems in neurological signals that travel between the structures in your ear to your brain.

Here’s a look at the similarities and differences between tinnitus and hyperacusis.

Tinnitus

People with tinnitus experience a persistent or continuous sound in their ears without an evident external source.

Tinnitus is common, with some surveys estimating that it affects up to 10% to 25% of adults.

The sound produced by tinnitus has been described as:

  • ringing
  • buzzing
  • roaring
  • whistling
  • humming
  • clicking
  • hissing
  • squealing

Factors that may contribute to the development of tinnitus include:

Tinnitus can occur in one or both ears and can be persistent (non-stop) or come and go.

Hyperacusis

People with hyperacusis are overly sensitive to sounds. For example, someone speaking may suddenly trigger pain or discomfort.

Research suggests hyperacusis may occur in 3.2% to 17.1% of children and 8% to 15.2% of adults. Exact estimates of the prevalence of hyperacusis and tinnitus are difficult due to the subjectivity of symptoms.

Hyperacusis is often divided into four subtypes depending on the emotion that the sound triggers:

  • pain hyperacusis
  • annoyance hyperacusis
  • fear hyperacusis
  • loudness hyperacusis

Hyperacusis is common among people with tinnitus and may also co-exist with more than 20 non-auditory conditions, including:

Doctors rarely find the underlying cause of hyperacusis symptoms, but the most common risk factor is high noise exposure.

Hyperacusis almost exclusively occurs in both ears and rarely comes and goes.

Hyperacusis and tinnitus are strongly associated and frequently occur together, but research has not found a causal relationship.

In a Swedish study, researchers examined the occurrence of hyperacusis in 1,984 people with tinnitus and 1,661 without. They found that hyperacusis was associated with:

  • a 3.51 higher risk of tinnitus (95% CI 2.99–4.13)
  • a 7.43 higher risk of self-reported severe tinnitus 7.43 (95% CI 5.06–10.90)
  • a 12.1 higher chance of scores over 58 on the Tinnitus Handicap Index (95% CI 7.06–20.6), which indicate severe symptoms

As mentioned before, research has not found a causal relationship. Some surveys estimate that hyperacusis does occur in up to 55% to 85% of people with tinnitus.

In a 2024 study, researchers noted that 19.8% of people with tinnitus also reported symptoms of hyperacusis, compared to only 4.1% of people without tinnitus. The strongest risk factors associated with tinnitus in descending order were:

  • hearing loss
  • dizziness and imbalance
  • hyperacusis
  • very loud occupational noise exposure

The main treatment options for tinnitus include:

  • sound therapies such as:
    • tabletop or smartphone sound generators to help you sleep
    • wearable sound generators to provide relief throughout the day
    • hearing aids to improve hearing loss
  • behavioral therapy, which might include:
  • medications such as antidepressants or anti-anxiety drugs may improve low mood (common among people with severe tinnitus) and help with sleep regulation
  • combination devices that act as hearing aids and also act like sound generators

Some treatment options for hyperacusis may include:

  • sound therapy, which might involve wearing earpieces that produce white noise
  • CBT to reassess negative or distressing thoughts related to hyperacusis and anxiety
  • controlled sound exposure therapy to reintroduce you to sound

Tinnitus refers to a ringing or buzzing sound in one or both ears that doesn’t have an external source. Hyperacusis is an oversensitivity to sound that may cause pain, annoyance, or fear.

Tinnitus and hyperacusis often occur together, but the underlying cause of these two conditions is not understood. An audiologist or physician can help diagnose these conditions and develop a treatment program.