At Hyperacusis Guide, we strongly disagree with the widespread narrative that isolating from sound leads to worsening of hyperacusis symptoms ─ a narrative that has been pushed since Dr. Jastreboff and Dr. Hazell introduced tinnitus retraining therapy (TRT) in 1993.

Many new hyperacusis sufferers often turn to online platforms like Reddit, where the majority of the advice they receive encourages continued exposure to everyday sounds with the expectation that their symptoms will improve, and warns that avoiding or isolating from sound may cause their symptoms to worsen. Unfortunately, this is usually the same advice newly affected patients will receive from doctors, audiologists, and clinicians, who generally lack experience in managing hyperacusis.

Our firsthand experience and case reviews suggest that even a mild case of hyperacusis can rapidly progress to a severe or catastrophic level if normal sound exposure is continued. We are aware of numerous individuals who were initially mildly affected, followed exposure therapy advice from Reddit and other sources, and subsequently became completely homebound, unable to work, and profoundly disabled by their condition. We believe that earlier sound isolation when symptoms were mild could have prevented this escalation in many cases.

Precautionary Guide for New Hyperacusis Patients

This guide outlines what we believe is the most effective course of action for individuals newly affected by hyperacusis. It reflects our experience and observations, aiming to help stabilize symptoms, prevent worsening, ensure accurate diagnosis and treatment, and provide the best chance for improvement.

Important Note

This protocol offers cautionary guidance based on evidence that sound exposure can worsen hyperacusis symptoms, and is designed to support recovery in the most effective way possible. Most individuals improve over time, gradually discovering safe sound levels tailored to their sensitivities. Many eventually relax certain limitations once stability is achieved. We believe that taking extra precautions early on increases the likelihood for improvement later, whereas insufficient caution early on can result in severe, long-term limitations.

Know your limits and do not risk exposure beyond them. Symptom worsening from overexposure can be difficult to recover from, and in some cases may lead to long-term or seemingly permanent symptoms.

It is common for family members to urge you to seek treatment upon recognizing the extent of your difficulties. However, because severe hyperacusis is a rare and poorly understood condition, even well-meaning advice can be harmful. In some cases, families may even assume the condition is purely psychological ─ an impression often reinforced by misinformation found online.

**Remember that if someone pressures you into treatment that exposes you to sound levels beyond your limits (tinnitus retraining therapy (TRT), inpatient psychiatric treatment, etc.) resulting in a setback, you are the one who must live with the consequences. No one else will experience your suffering firsthand.**

These measures may seem extreme, and many healthcare professionals and online sources often recommend the opposite. However, hyperacusis remains poorly understood within the medical community, and there is still very limited research on the condition. Many individuals with severe symptoms report wishing they had adopted these precautions earlier. Taking careful measures early on is far better than enduring irreversible consequences later.

1. Controlled, Predictable Sound Environment

• Create a quiet home environment where sound levels are predictable and consistently below your discomfort threshold.
• Eliminate sudden, unpredictable noises (door slams, kitchen clatter, TV/radio, etc.).
• Avoid any sound that causes pain, burning, flare-ups, or worsening of symptoms, even if it is not "loud" by normal standards.

2. Protective Equipment Use

• If outside of your safe home environment (especially when driving or riding in a vehicle):
• Use double protection: high-NRR foam earplugs plus quality over-the-ear earmuffs such as Peltor X5A.
• Keep protection on for the full duration of the trip.
• Avoid removing protection in noisy spaces, even briefly.
• Keep spare earplugs and earmuffs accessible at all times.

3. Digital Audio Elimination

• Zero digital audio exposure:
• No headphones, earbuds, or speakers playing music, podcasts, or videos.
• No phone call audio ─ use live captioning, text, or email options instead.
• Limit all non-essential media, even at low volumes, until stability improves.

4. Homebound Voluntary Precaution

• Minimize leaving home except for essential medical visits. This precaution may be temporary but is important in the early phase to prevent irreversible setbacks.
• Arrange errands, deliveries, and communication so you can maintain a low-noise environment.
• This will likely require you to stop working, at least temporarily, but it’s far better to take a planned break now than to risk worsening your condition and being forced to stop working due to an irreversible setback.

5. Diagnostic Imaging

• Schedule a high-resolution CT scan of the temporal bones (thin-cut protocol with <= 0.6 mm slice thickness, non-contrast).
• Purpose: Rule out bony or structural causes (e.g., superior semicircular canal dehiscence syndrome) and evaluate surgical options.
High-resolution temporal bone CT is a very common study and nearly every hospital and imaging center has a standardized protocol for this exam. Any ENT specialist should be able to order this exam, however, after the imaging is completed you will likely need to find, or be referred to, a highly-specialized ENT (otolaryngologist) or neurotologist with experience treating hyperacusis ─ ideally with expertise in the Silverstein Procedure.

6. Specialist Review

• Review CT results with a competent ENT (otolaryngologist) or neurotologist experienced in:
• Updated Silverstein round/oval window reinforcement surgery.
• Tympanic membrane "paper patching" technique.
• Botox injection into the tensor veli palatini (TVP).
• Sphenopalatine ganglion (SPG) nerve blocks.

It is important to approach medical appointments with realistic expectations. Most healthcare providers are unfamiliar with hyperacusis and noxacusis (pain hyperacusis), and even fewer understand how to manage these conditions effectively. If you visit a random ENT specialist, they will likely not be aware of the Silverstein Procedure or TVP Botox and may minimize your concerns. You should prioritize finding a specialist with expertise in the Silverstein Procedure, and some of them provide the option of virtual appointments.

As for audiologists, their role is usually limited to conducting a basic hearing test and, in some cases, recommending tinnitus retraining therapy (TRT), which is generally ineffective and likely harmful for those with severe sound intolerance.

7. Treatment Planning

• Discuss possible interventions after imaging.
• Ensure the provider can perform, or refer for, all above options if indicated.

8. Time & Preparedness

• Improvement often takes time and varies by individual.
• Securing useful medical interventions early and having them available as options is wise, so you are prepared if you decide you need them. If you wait until you are severe it may become very difficult to access the tests and appointments.

9. Medication Caution

• Avoid psychiatric medications unless absolutely necessary for safety or mental health crisis.
• Many psychiatric meds can affect auditory processing and may complicate recovery.
• Some people use benzodiazepines occasionally for travel or acute situations, but this should be rare.
• Continued use of benzodiazepines can create dependency, with addiction potentially developing within a few weeks, and may significantly worsen the condition.
• If any psychiatric meds are used, they should be short-term.

10. Lifestyle & Mental Health Support

• Consider incorporating activities that promote calmness and overall wellness, such as:
• Gentle movement practices like yoga, Qigong, or Tai Chi.
• Meditation or prayer.
• Reading uplifting or positive books.
• Spending time in quiet nature environments.
• Light to moderate exercise within safe sound limits.
• Eating a healthy whole-food diet.
• Limiting time with people who are consistently stressful, unsupportive, or dismissive of your needs.
These are suggestions ─ find what works best for your body and mind.

11. General Precautions

• Avoid trial-and-error sound therapy. You will get plenty of sound enrichment even in your quiet home. Sound is everywhere.
• Rest, adequate sleep, and stress management are essential.
• Avoid procedures that may worsen your condition, including:
• MRI scans (due to loud noises and vibrations).
• Loudness Discomfort Level (LDL) testing.
• Ear microsuction or irrigation procedures.
• Dental procedures, especially those involving drilling or ultrasonic cleaning.

12. Workplace & Disability Accommodations

• Explore available options such as:
• Family and Medical Leave Act (FMLA).
• Americans with Disabilities Act (ADA) workplace accommodations.
• Short-term and long-term disability benefits.
• Work-from-home opportunities that minimize or eliminate audio exposure.
Utilizing these resources early can help reduce stress and support you financially. Regardless of what some may say, hyperacusis is a disability and presents many limitations in life and work.