Hyperacusis and Tinnitus: Prevalence and Daily Impact

Approximately one in six patients with chronic tinnitus also has hyperacusis, according to a study of 194 individuals. This comorbidity is linked to a substantially greater burden from tinnitus and lower tolerance for everyday sounds.

## How the Study Measured Sound Tolerance in Tinnitus

To understand the relationship between tinnitus and hyperacusis, researchers Snežana Babac, Aleksandar Perić, and Vladan Milutinović conducted a cross-sectional study with 194 patients aged 21 to 85. All participants had chronic subjective tinnitus. The team used a multi-method approach to identify hyperacusis, moving beyond a simple questionnaire.

First, they conducted a structured clinical interview, asking specific questions about decreased sound tolerance and whether sounds ever caused ear pain. Second, they performed objective uncomfortable loudness level (ULL) measurements, a standard audiological test. This test determines the lowest volume at which a sound becomes physically uncomfortable. Patients were then categorized into two groups: those with tinnitus and hyperacusis (T + H), and those with tinnitus alone (T). The impact of tinnitus on daily life was quantified using the well-validated Tinnitus Handicap Inventory (THI).

## Tinnitus with Hyperacusis Doubles the Perceived Handicap

The findings reveal a clear and significant difference in patient experience. Of the 194 patients, 32 (16.5%) were identified as having hyperacusis. The THI scores, which measure the tinnitus-related burden, were dramatically higher in the T + H group. Patients with hyperacusis had an average THI score of 76.3, compared to a score of 41.9 for those with tinnitus alone.

This difference is not just statistically significant—it is clinically meaningful. A THI score above 56 is classified as a “catastrophic” handicap. The average score for the T + H group falls well into this severe category, while the average for the tinnitus-only group is in the “moderate” range. This indicates that the presence of hyperacusis more than doubles the perceived life impact of tinnitus.

The objective ULL data supported these subjective reports. Patients with hyperacusis had significantly lower ULL values across tested frequencies. This means they reached their threshold of sound discomfort at much lower volumes than their peers without hyperacusis, confirming a physiological basis for their reported sensitivity. For more on the complex links between these conditions, see our article on Tinnitus, Hyperacusis, and Anxiety After Brain Injury.

## Why Routine Hyperacusis Screening is Essential for Tinnitus Care

This study has direct implications for clinical practice. The prevalence of 16.5% shows that hyperacusis is a common, not rare, companion to chronic tinnitus. Because it is associated with a far greater handicap, failing to identify it means clinicians are missing a key part of a patient’s auditory health profile.

The authors argue that a structured interview combined with ULL measurements should become a standard part of the tinnitus evaluation. Relying on patients to volunteer symptoms of sound sensitivity is not enough; systematic assessment is required. Identifying hyperacusis changes the management approach. Treatment plans may need to incorporate sound therapy strategies designed to gently increase sound tolerance, rather than just focusing on tinnitus masking or habituation.

Furthermore, the lower ULLs suggest an underlying auditory system dysfunction that may involve the central auditory pathways. This aligns with research using tools like the Auditory Brainstem Response to understand neural health. Recognizing this dimension can guide more personalized and effective interventions.

## A Clear Call for Comprehensive Auditory Assessment

The research by Babac and colleagues provides strong evidence that tinnitus and hyperacusis frequently co-occur, and that this combination creates a more challenging condition for patients. The nearly twofold increase in tinnitus handicap score is a compelling reason to change standard care protocols.

For patients struggling with tinnitus, this study underscores the importance of discussing all symptoms of sound tolerance with their audiologist or hearing care specialist. A comprehensive assessment that actively looks for hyperacusis is the first step toward a management plan that addresses the full scope of their auditory experience. As our understanding grows, so does the potential for better outcomes, similar to progress seen in other specialized areas like Audiologist-Led Tinnitus Care.

**Source:** Babac S, Perić A, Milutinović V. Hyperacusis in Patients with Chronic Subjective Tinnitus: A Cross-Sectional Study. *Audiology Research*. 2026;16(5):126. doi:10.3390/audiolres16050126.