A jovial laugh, to Tom Maholchic, feels like a knife stabbing his eardrums. So do all sorts of routine sounds — the sizzle of bacon, the ring of a phone, the rush of running water.

“I feel like I have a year-round sunburn deep inside my ears,” said Maholchic, 27.

Researchers have known for years about a condition called hyperacusis, where ordinary sounds seem uncomfortably loud. But they’re just starting to understand that some patients experience a more severe form, where noise is not just heard — but is actually felt, as physical pain.


Using new lab tools and techniques, pioneering scientists have identified what appear to be pain fibers in the inner ear, or cochlea. They are coining new terms, including “noxacusis” and “auditory nociception,” for this newly recognized sensation of noise-induced ear pain.

The new diagnosis will be an important topic next week at the annual meeting of the Association for Research in Otolaryngology in San Diego, where a three-hour symposium will introduce the research and explain its implications. While some patients with the condition do improve, others risk a setback every time they hear even a moderate noise.

“People’s lives have been radically altered by the crippling pain that comes with this type of rare noise injury,” said Bryan Pollard, president of Hyperacusis Research, a nonprofit.

“The pain lingers long after the sound is gone, much as the pain from a flesh wound would.”

M. Charles Liberman, Harvard Medical School

Patients’ descriptions of the pain are remarkably similar: A sound is usually perceived as the sharp jab of a knife or skewer. The sensation persists as a searing, burning ear pain, often combined with the pressure known as aural fullness and the ringing known as tinnitus.

Maholchic often spends time in this room, so he can look outside the window and feel the sun, since he cannot tolerate going outside during the day. He says that he spends most of his time reading and painting. Kayana Szymczak for STAT

“What even most auditory scientists don’t understand about hyperacusis with pain is that the pain lingers long after the sound is gone, much as the pain from a flesh wound would,” said M. Charles Liberman, a professor of otology at Harvard Medical School and director of a hearing research lab at the Massachusetts Eye & Ear Infirmary.

The problems start with the pea-sized cochlea, a tiny sensory organ buried within a skull bone. It’s tough to reach and impossible to biopsy, thereby hampering experimental work. Within the cochlea, one kind of nerve fiber has long puzzled scientists. These mystery fibers resemble pain fibers elsewhere in the body.

It took 15 years, but using several strains of deaf mice, Jaime García-Añoveros, an associate professor of anesthesiology at Northwestern University Feinberg School of Medicine, found that intense noise causes activity in these fibers. That research, coauthored by Liberman, was published last March in Current Biology.

At around the same time, a lab at Johns Hopkins University found that when certain sensory cells of the cochlea are damaged, as might occur during very loud noise, they release a chemical that activates the mysterious pain fibers. In some people, these fibers seem to switch on — and never switch off.

Noise loud enough to cause immediate pain — like a gunshot or a firecracker going off at close range — is so rare that few people ever experience it, except those in the military.

But exposure over time to more modest noise — from music, movies, sirens, lawnmowers, and a thousand other everyday things — can damage hearing and set off the pain fibers.

Indeed, noise can cause damage even if it doesn’t feel uncomfortably loud in the moment. “Young people don’t report a rock concert as a painful experience,” said Paul Fuchs, a professor of otolaryngology at the Johns Hopkins University School of Medicine, whose research was published in the journal PNAS in November.

Individual susceptibility to noise exposure varies greatly, and may be genetic. There’s no firm estimate of how many people may suffer from noise injury.

Maholchic’s collection of noise reduction earmuffs. Kayana Szymczak for STAT

Few doctors or audiologists are even aware of the condition, though the new findings may encourage them to take patients who complain of ear pain more seriously. “It is time for pain hyperacusis to be recognized as a real symptom, not as a psychosomatic phenomenon,” García-Añoveros said. “This is, in a way, a new sensory modality — a hybrid of pain and hearing.”

For Maholchic, the pain came on abruptly and quite unexpectedly. He never thought his noise exposure was at all unusual. At his student job at the University of Massachusetts, he listened to music on his iPod while he vacuumed. He played in a garage band. Later, he worked at a loud, lively restaurant.

His only symptoms were ear fatigue after band practice and bursts of discomfort from clanking dishes at the restaurant. These warning signs, seemingly inconsequential, quickly resolved.

One night two years ago, however, his ears started ringing. Within weeks, “barking dogs, crowded places, and pretty much any noise considered remotely loud sent shockwaves through my head,” he said in an interview conducted by email, since he must limit his time on the phone.

Maholchic had been living in California, but moved back in with his parents in suburban Boston because the pain was so debilitating. To cushion him from noise, the house has soundproof windows and plenty of carpeting. Maholchic also sometimes wears earplugs or protective earmuffs. And he rations his time spent in potentially painful settings. “If I manage my noise exposure well, I can handle noise better,” he said.

Maholchic has improved enough to be able to take occasional late-night walks while his neighborhood sleeps. But just one surprise noise, like a honking horn, erodes his progress.

“The louder the noise, the greater the impact,” he said. “It angers me to think about all the unnecessary noise I exposed myself to. I was unaware of the harm it could cause.”

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  • I have, apparently, a nd form of hyperacudis. Sharp, sudden sounds really do feel like an icepick in the ear. But it doesn’t linger very long. Usually just a few seconds. Percussive sounds like loud sneezes do it every time. The barking of small dogs up close also does it.

  • have notice for awhile pain with sounds and this morning when turned on comp the sound from the comp fan I guess hurts. funny part just had my ears check and he said had hearing loss of 15/ 20 % have simple sensory auditory seizures wonder if connected??

  • I’m here because i’ve been researching the condition lately to explore treatment options for my mother who’s suffering enormously at the moment with this condition. After reading all your comments I couldn’t not link this for you in the hopes that it could help any of you


    It’s the Silverstein institute based in florida I believe. I’m not 100% certain where they’re at with this treatment, whether it’s still being tested in control groups or not, but I have watched some of their videos on youtube. Testimonials from patients that have undergone the ‘Round and Oval Reinforcement’ surgery state they’ve had significant improvements with their conditions and the pain. Some even say that it’s given them their life back. If you haven’t come across this yourself already, i’d recommend looking into it and reaching out to them to discuss potential options. It may cost, i’m not sure, but still worth reaching out to them to find out.

    • Thank you Lewis. I’ll take a look. Willing to fly anywhere and more or less pay anything to get my life back.

  • I’m so pleased to find you all though sad to hear everyone else is suffering like me. 18 months ago I had nothing wrong with my ears or hearing. I went to a private ENT surgeon as my ears felt blocked and he microsuctioned them. From that date I developed horrendous hyperacusis and pulsatile tinnitus i developed severe migraines ( at least 15 days a month in bed) just to add to the triad of pain. I have had eighteen months almost full time chasing drs, paying privately for consultations and scans and getting absolutely nowhere.
    I am an extremely fit gym going active female running a business, luckily from home but this has changed my life. Not only the constant pain but the inability to go out due to noisy shops, coffee shops, restaurants etc. Even my husbands throat clearing and sneezing are agony for me. Family gatherings are purgatory because I can’t keep asking people to lower their voices. I worry when my grandchild is born next year that I’ll be able to look after him.
    I have no help whatsoever in the UK. They just say live with it. I’m prepared to fly anywhere in the world for help so I would love to have your advice and suggestions of where to come. Jan

  • My hyperacusis is accompanied by tinnitus, and after reading up on it all a lot I discovered this is the same for many people suffering from this. Problem is they say adding in white noise can help tinnitus but then it irritates me so much because of my sensitivity to sounds. So I’ve resorted to trying all sorts of herbal therapies. Recently I started taking Lipo Flavonoid Plus. Didn’t see results at first but after a couple months of sticking to it I’ve now noticed improvements. I’d recommend trying anything and everything honestly because you never know what will work for you. This is not a one size fits all issue. Lipo has a 60 day money back guarantee too so no loss if it doesnt work for you. https://lipoflavonoid.com/

  • HI everyone for the last 12 months I have had pain to noise but not in my ear in my forehead or head like twinges of pain. Also a sensation across my face to noise all these noises are not loud infact I can cushion these if the sound around me is louder so I don’t hear these noises. Light switch dog sneezing top off the toothpaste my voice and other peoples. I also have a feeling something is stuck in my ear all the time and it contracts to these noises also

    Thank you for reading I’d be so grateful if you would be able to advise me on if you think this is hyperacusis sound is not ampufied either to me.
    I have a heavy feeling like my eardrums being sqeezed and a dull feeling to and numb feeling around my ears.

    Thank you all again

    Wishig everyone good health.

  • Oh my goodness this is me!! Finally iv found others who have this. Iv had this horrendous problem for 2 years. I’m expected to work and no one believes me. I have to walk around with thick head phones to block out the noise and pain!! I’m begging for help for this to stop. Is there any Drs out there to help. I live in nsw

    • There’s no help. You can improve from time, protection and TRT but you ca’nt be cured. Hyperacusis is a lifetime disability.

  • Hi, I have severe hyperacusis which began after taking the antidepressant Paxil.
    I didn’t realise what was happening, and it gradually got worse over a 2 week period. It’s been 3 years now, and, despite the fact I have other serious medical conditions, it means I can’t go out anywhere.
    Going to the doctor I put in earplugs, but it’s still hell, as they don’t completely block the sound.
    At home most people try to be quiet, but they just don’t get it. If I say stop, I mean stop. And whisper means please really whisper!
    I ask the doc to whisper but he talks loudly, has no idea.
    He’s finally sending me to a neurologist, but I have to get well enough to go.
    For me, the pain isn’t in my ear at all, really, it’s more just through all my nervous system. Can anyone else relate?
    I feel I would have healed from my other illnesses to a great extent, but this keeps the adrenaline and cortisol constantly pumped, which affects everything else.
    The guy I live with is having some sort of breakdown and screamed at me a month ago when on sick leave, and my tolerance, which was very gradually improving, went backwards a long way.
    I cry and try to keep myself ostracized, but people just have no idea.
    My mother is visiting and kept rattling hangers,and I was begging her to stop.
    In the end I screamed at her to stop, but she left the room in a huff, yet I thought she of all people understood. Feeling very stressed and depressed.
    I’m on Oxycodone for my CNS pain, and no neurologist can work out that either.
    The Oxycodone maybe takes the edge off the hyperacusis, calms the N.S. but doesn’t do that much for the hyperacusis. At least it treats the nerve pain brilliantly. I wouldn’t be here without that intervention.
    Any input greatly appreciated. Thanks.

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