Hyperacusis: Reduced Sound Tolerance and Its Impact on Musculoskeletal Health

Hyperacusis refers to a reduced tolerance for everyday environmental sounds at intensities that most people find comfortable. People with hyperacusis may experience ordinary sounds, conversation, traffic, kitchen noise, the sounds of a supermarket, as uncomfortably or even painfully loud. The condition affects an estimated two to three percent of the general population and is significantly more common in people with certain medical conditions and neurodivergent presentations.

While hyperacusis is primarily an audiological and neurological condition, its physical and musculoskeletal consequences are significant and are rarely discussed in the context of audiological care. Understanding these consequences opens the door to integrated support that addresses the whole person rather than just the auditory pathway.

Who Develops Hyperacusis

Hyperacusis can develop following exposure to very loud sound (acoustic trauma), as a component of tinnitus, following head injury or whiplash, in the context of post-viral syndromes including post-COVID presentations, and as a feature of certain chronic pain conditions. It is also significantly more prevalent in neurodivergent populations: research suggests that between 40 and 75 percent of autistic people experience some degree of hyperacusis, making it one of the most common and impactful sensory differences in autism.

The relationship between hyperacusis and anxiety is bidirectional: anxiety lowers the threshold at which sounds are perceived as threatening, and hyperacusis increases anxiety. This creates a self-reinforcing cycle that can be extremely difficult to interrupt.

The Physical Cost of Living with Hyperacusis

The primary physical consequence of hyperacusis is chronic, sustained muscle tension produced by continuous activation of the acoustic-startle and threat-response systems. The trapezius and levator scapulae, which elevate the shoulders and brace the neck in response to threatening sound, are in a near-constant state of partial activation in people with significant hyperacusis in ordinary environments.

The deep cervical flexors, which brace the head in response to sudden sounds, are similarly overloaded. The jaw muscles, involved in the protective clenching response to threat, often develop sustained hypertonicity. The result is a presentation characterised by severe upper thoracic and cervical tension, frequent headaches, jaw pain and restricted neck movement that can appear superficially similar to work-related or postural pain but has a different underlying driver.

Additionally, the chronic sympathetic activation that hyperacusis maintains has systemic effects including heightened pain sensitivity, disrupted sleep, impaired immune function and fatigue, all of which compound the musculoskeletal picture.

Chiropractic Care as Part of an Integrated Approach

Chiropractic care is not a treatment for hyperacusis itself but is well-positioned to address its physical consequences. Releasing chronic tension in the trapezius, cervical and thoracic spine, and supporting autonomic nervous system shifts toward the parasympathetic state through techniques such as Network Spinal addresses the accumulated musculoskeletal load of chronic sound-related stress responses.

At Clifton Chiro in Bristol, care for patients with hyperacusis is integrated with an understanding of the neurological underpinnings of their presentation. The treatment environment is kept quieter than typical healthcare settings, and the approach is structured to minimise unpredictable sensory input. For patients managing hyperacusis alongside other health conditions, chiropractic care can form a valuable component of a broader integrated support strategy.

References

1. Tyler RS et al. A review of hyperacusis and future directions. American Journal of Audiology. 2014.

2. Gu JW et al. Tinnitus and hyperacusis: molecular and cellular mechanisms. Frontiers in Neurology. 2019.

3. Green SA et al. Neurobiology of sensory overresponsivity in youth with autism spectrum disorders. JAMA Psychiatry. 2015.

About the Author

Tim Scott is the Principal Chiropractor at Clifton Chiro, with over 26 years of experience in healthcare.

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