Hearing, Tinnitus and Balance Clinic

Let's hear it.


Are everyday noises bothering you too much? 

Do you feel overwhelmed with the sounds around you?

Hyperacusis can be defined as the decreased tolerance to sound.  It occurs in approximately 2% of the population, including children.  Hyperacusis is often associated with tinnitus, migraine, insomnia, autism, facial paralysis, depression and stress.  Usually, hyperacusis reflects inappropriate or exaggerated responses, not just to loud sounds or specific sounds, but to sounds in general, such as everyday environmental sounds.  It is often accompanied by ear ache.  Under the umbrella of hyperacusis, the conditions misophonia (a dislike of sounds) or phonophobia (a fear of sounds) may also be present in some patients. In misophonia, a negative reaction to a sound occurs when the emotional and auditory systems offer heightened responses, even when the stimulation of the auditory system was not abnormal.  This leads to a negative emotional experience of sound.  

Hyperacusis often has a very serious impact on the patient’s emotional and functional wellbeing.  Patients report that they do not want to go to work, to social events or even take part in standard daily activities because it is too stressful with all those sounds around them, or because they fear that a sudden sound may come up and upset or hurt them.  The mechanisms of hyperacusis are much on the same basis as tinnitus mechanisms, involving the auditory and central pathways, with a strong activation of the limbic or emotional system.  When patients fear that a sound will hurt them or that the condition will become worse, they start to avoid auditory stimulation, but this sensitises the auditory system, which intensifies the hyperacusis further.

Naturally, it seems like a good idea to use earplugs or ear muffs to protect yourself from sounds if you are sensitive to noises, but this will in fact only worsen the hyperacusis.  Noise protection should be worn when one is exposed to excessively loud noise that could cause damage to the ears, such as gun shots (hunting) and loud machine noise.  However, if they are used to block everyday sounds, they reduce auditory gain, which lead to increased central gain of sound as a compensation for the lack of sound – resulting in even worse hyperacusis. A much more successful method of treatment are Tinnitus Retraining Therapy (TRT) and Cognitive Behavioural Therapy (CBT), which aims to educate the patient about the auditory, central and emotional systems involved in hyperacusis, and to teach them techniques helping with desensitisation and habituation.  When the patient learns to think differently about the noise and acquires a positive relationship with sound, he/she automatically becomes less bothered by sounds and is able to take part in everyday activities more and more. A desensitisation program for sound compliments the TRT and CBT in helping the patient to tolerate sounds better.

Our team’s audiologists and psychologists are trained in delivering CBT.  They form an excellent team when combining their knowledge to help the patient in different aspects.  The audiologist will be especially valuable in educating the patient on ear-related aspects of hyperacusis so that the patient will feel less confused and understands the condition so much better, that they can be helpful in designing their own intervention plan.  Hyperacusis-focused CBT and desensitisation is done by the audiologist.  Referrals are only made to the psychologist as deemed necessary by the audiologist and patient.  The psychologist has in-depth knowledge and years of experience in dealing with thought patterns and emotional related matters.  He delivers prised support empowering the patient to take back the control and to face life with all its sounds.

Get ready to face and enjoy the sounds of life – contact us for outstanding support.

How do I know if my child perhaps has hyperacusis and what should I do?

Hyperacusis definitely occurs in children as well and should be treated before it develops into a serious condition that debilitates their adult life. If your child frequently covers his/her ears for sounds that may not have struck you as being that loud (for instance, dogs barking, traffic noises etc), starts crying in response to sounds or avoids certain situations due to a fear of noises, please come in for an assessment. Children are immature in their emotional development and might have difficulty processing the meaning of sound if it happens to be distorted by auditory and central pathways. In therapy, education about the ear and CBT is adapted for children and can be very successful in helping with desensitisation.

I am not deaf and my ear is not sick, so how will an audiologist be able to help me?

The audiologist is trained extensively in understanding the ear and related conditions. It is crucial for the patient to understand how hyperacusis works in order to manage it. Doctors rarely have the time to explain such complicated systems thoroughly, therefore the audiologist takes over the role of the educator. Hannelie Kroon has received specialised training about hyperacusis in Denmark and in England and is equipped to provide expert treatment. She also knows when to involve psychology and backs the patient through the whole journey.

Do the medical aids cover the treatment?

The sessions are billed either as audiological or psychological services rendered, which are approved by the Health Professional Counsel of SA and therefore covered by medical aids provided that your funds are not depleted.


I am excited to announce that I have entered the Interational Conference on Hyperacusis to be held in June 2017 in Guildford, England.  This conference is an excellent platform to gain more knowledge on the complicated matter of hyperacusis, learning from top researchers and clinicians in the...