ENT innovation: All about the hyperacusis procedure

Hyperacusis is a rare but distressing hearing condition where every day sounds are perceived as uncomfortably loud or even painful. While it can vary in severity, in some cases it significantly affects a person’s ability to function in daily life. People with hyperacusis may struggle with routine environments such as busy streets, social gatherings, or even household noises. Although many patients are managed successfully through therapy and sound desensitisation, in select cases, a surgical procedure may be considered.

What is hyperacusis and who does it affect?

Hyperacusis occurs when the brain amplifies sound signals coming from the ear, often due to changes in the way the auditory system processes sound. It is not the same as hearing loss or tinnitus, although these conditions can occur together. For individuals with hyperacusis, even soft sounds like running water or paper rustling can seem unbearably loud.

The condition may arise after noise exposure, head injury, ear surgery, or certain neurological or psychiatric conditions. However, in many cases, no clear cause is found. It can affect both adults and children, and it often leads to social withdrawal, anxiety, and poor quality of life if left untreated.

How is hyperacusis diagnosed and managed?

Diagnosis is made through a detailed clinical history, hearing tests, and specific assessments that measure sound tolerance, such as uncomfortable loudness level (ULL) testing. These tests help distinguish hyperacusis from other auditory conditions.

Most patients are initially managed with non-surgical interventions. These may include:

• Cognitive behavioural therapy (CBT) to reduce sound-related anxiety
• Tinnitus retraining therapy (TRT) which combines sound therapy with counselling
• Custom sound generators to promote gradual desensitisation

These approaches are often effective over time, but a small group of patients with severe, persistent symptoms may be candidates for a surgical option.

Surgical treatment for severe hyperacusis

In 2018, a surgical technique to treat hyperacusis was introduced to the UK by consultant ENT surgeon in Teesside, Mr Anirvan Banerjee, marking a significant advancement in management for complex cases. The procedure involves reinforcing the round and oval windows of the middle ear using a soft tissue graft. These structures play a key role in sound transmission and pressure regulation within the inner ear. Strengthening them can reduce the hypersensitivity to sound signals and relieve symptoms.

The operation is carried out under general anaesthesia and typically takes less than an hour. It is minimally invasive. Patients can often return home the same day.

What are the outcomes and considerations?

Early results from patients who have undergone this procedure have shown promising outcomes, with improved sound tolerance and reduced discomfort in response to everyday noise. However, it’s only considered in carefully selected cases where conservative measures have failed and where diagnostic tests support surgical intervention.

As with all ear surgery, there are potential risks, and patients considering the procedure should undergo a thorough consultation with an experienced ENT specialist to weigh the benefits and limitations.