Contribute Try STAT+ Today

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.”

  • Hello,
    Mine started with minor sound selectivity and then sudden exposure to loud noise of our home alarm system. since then( 2 years ago), I have a very loud reactive tinnitus which even get worse with white noise. I took Lexapro and Clonazepan for a year. After feeling better, ( less reacting tinnitus and sensitivity ) gradually stopped it. But after few months experienced this sharp pain in my ears and neck and migraine headaches and very loud tinnitus in both ears. Again starting taking Gabapentine and Clonazepam.
    My life in miserable . I believe I can’t try any sound therapy because any sound aggravate my tinnitus and first need to cure hyperacusis which I couldn’t find any, expect white noise therapy.
    Any one knowes if I still damage my ears while I am on medications and don’t feel that much pain and it kinda lowers my tinnitus loudness?
    I am so scared and so puzzled, really don’t know what to do!
    Is there is therapy anyone can suggest ?
    Is there any hope so I can get better one day?
    My doctor told sound sensitivity gets better when I get older ( I am 42 yesrs now) and loose some of my hearing. Is this true?

  • My wife has exactly the same symptoms as described in the article from a work injury 12 years ago where she was exposed to a constant fire alarm for around 45 minutes and has not worked since due to the constant pain. Here in the UK it seems no-one is aware of Hyperacusis let alone Hyperacusis with pain and this has in turn affected her mental health. At first ENT consultant told her it was made up, then it was her teeth, to live with it and all other excuses which were useless. She has tried TRT which failed and at the last Audilogy appointment was told there is nothing they can do.

  • My grand baby squeals with excitement and the pain hits me so hard in my right ear, it almost takes me to my knees…A car door is slammed and it sends me reeling in pain….I’m very hard of hearing and can not hear my wife, unless she turns her face towards me and turn the volume up one notch…then she get aggravated at me for saying it over and over and she turns her volume up maybe 5 times as loud and the pain hits my ear like a screw driver being poked deep in my head !
    Used to shoot rifles and shotguns ….cant do that anymore ! Retired now but worked at General Motors ….factory noise…Now I rarely leave the house !

  • I have a mild form of sensitivity to sound. I’ve never talked to my Dr. about it, but I can tell you it started after I took Effexor XR over 15 years ago. It hurts to hear a car horn, people coughing, a phone ringing, anything slamming, etc. It is usually only in the moment, and doesn’t linger more than a few seconds so I guess I’m lucky as far as that goes. But it is super annoying and somewhat painful when someone at work has a cold and is coughing all day.

  • Now try to imagine: every sound…EVERY sound I can hear, with 80 % hearing loss, triggers all-body tremors. Even some I am barely aware of, if there is rhythm or grinding noise, my nervous system experiences shock. No research here to turn to for answers. Forget music, TV, movies, restaurants…most social life.

  • I experienced this on a plane ride in the back by the engines. Dishes crashing with carefree busboys are also painful as are my husband’s “screaming” high pitched sneezes. After the plane ride my ears rang for two days.

  • This is an interesting post.
    I have had pain in the ears on loud noises for 5 years. It’s been diagnosed variously as tinnitus and hyperacusis. This is an interesting article as it focusses on the pain. Sure I get the ringing and it’s loud and distracting – and I wish I didn’t have it. However, I can ignore it. The pain I cannot ignore. If I ride in certain cars, at the time I don’t really feel anything at all out of the ordinary. Then over the next 24/48 hours I get ear fullness and sharp constant pain which spikes on loud noises – hypersensitivity with severe pain. Gradually, over time – say 1 week it subsides leaving me only with the tinnitus.

    So some observations……..

    The pain starts at least 18 hours after the noise which I would say has caused this. There’s always a trigger to make this worse. Why after, not at the time?
    It’s accompanied by ear fullness.
    The pain is not near my ear, it’s in my ear- deep inside it.
    Swallowing gives minor relief – sort of feels connected to the pain site.
    I can pop my ears.
    No pain killers touch it.
    For me, much worse in right ear.
    Sound Therapy pointless as its not an awareness thing – it’s real pain!
    The medical profession I’ve consulted don’t really believe these symptoms and in what I would describe as astonishing arrogance, tell me I don’t feel pain but I only think I have pain …….. So if you don’t know what it is, it must be that the patient is wrong about their symptoms.
    The noise in cars (which is the single worst thing for me) might be vibration as much as noise – ear plugs don’t always stop this!
    It’s better when I first wake up.
    Worse the first day it starts and then diminishes so almost feels like part of a “healing” process.
    I’ve tried ear grommets – make no difference.
    Sometimes when I take hay-fever tablets it feels a little better.
    I have good hearing – as tested by audiologist – very good in fact.
    If it’s very bad, I get a stiff neck also.
    It’s not all loud sounds that kick this off.
    I’ve had several sports cars. If I’m track racing – never a problem, even without ear plugs but I have a helmet on- maybe the sound gets in via bone conduction and it’s that which causes the issue?
    Noise cancelling headphones no good – simple plugs better.

    I’d be fascinated if there is any further serious reading on this topic. I’ve tried to set out some of the things I’ve noticed about my condition but this might not be the same as other people’s. I’d read anything,particularly anything which contains real understanding and practical ways to manage this condition or pain management suggestions I search the net on various search headings almost daily and this is the first time I’ve ever seen anything focussing on pain – which for me is the difficult bit to tolerate.



    • Hi there buddy, do you have hypersensitivity to some sounds like rubbing fabrics each other or when people walk through a carpet and feels like if a dental drill is inside your ear canal?

    • Hey man, i feel like i could have written your comment. only difference for me is the pain comes after about ten minutes and lasts about an hour. if you find any real anwswers, pass them on .thanks

  • Hyperacusis is treatable for many people. I have hyperacusis. Sound therapy is very helpful (tinnitus re-training therapy, or TRT) to many people including myself. You can read about it here:

    Some people make a full recovery, others can recover enough to live a mostly normal life.

    The difficult thing about hyperacusis, is that excessive noise exposure will rapidly worsen it. The even more difficult thing about hyperacusis is that not enough noise exposure (ie, wearing earplugs all the time etc) will also make it worse. Gentle noise exposure, increasing over time helps desensitize the auditory system. Treatment can be extremely frustrating, but there is hope.

    I wear sound generators all day which emit quiet broadband sound, as well as do therapy by listening to noises at slowly increasing decible levels. It does work for me.

    Your article should discuss hyperacusis treatments. Even though the initial cause may indeed be ear damage, as discussed in the article, the brain can slowly learn to compensate and stop sending signals of loudness or pain inappropriately.

  • the search for relief went to the U.S.A about 34 years ago. Leading onto London 27 years ago – back home to South Africa. The answers to the diagnosis of tinnitus helped. The cause and cure(s) are unclear , and I am told remain so.

  • I’ve had a Quaker parrot for almost 2 years in August. As the baby grew so did its sounds. Lol
    2 weeks ago the bird named Jemma got excited as she does sometimes and loudly screeched a happy screech in my r ear. She of course was on my shoulder. I experienced a very sharp pain in my ear. Ever since this occurred my ear feels full of pressure ( like water in the ear with no swish.) I also get a knife stab like pain off and on which makes me scream. This comes and goes along with a noise like an ear test makes….eeeeeeeee. Is my ear damaged. You were the only one I could find to explain this. All other things on google regarding ears said ear infection ect. Should I see an ear doc to or will this go away … Thank you so much for your article.

    • I had a similar experience. A sudden loud car honk near me gave me a stabbing, throbbing pain in my ear that has persisted for almost a day now. I feel in pain and am concerned that damage has been done.

    • Hi have you had any progress I went to a concert and now my ear aches and I can hear about 3/4 what I used to hear, please let me know if things got better

Comments are closed.

Your daily dose of news in health and medicine

Privacy Policy