HYPOTHESIS PAPER
LOUDNESS HYPERACUSIS: MECHANISMS OF LOUDNESS PERCEPTION AND THEIR BREAKDOWN
 
 
 
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Psychology, University of Cambridge, United Kingdom
 
 
A - Research concept and design; B - Collection and/or assembly of data; C - Data analysis and interpretation; D - Writing the article; E - Critical revision of the article; F - Final approval of article;
 
 
Submission date: 2024-10-21
 
 
Final revision date: 2025-03-20
 
 
Acceptance date: 2025-05-08
 
 
Online publication date: 2025-12-19
 
 
Publication date: 2025-12-19
 
 
Corresponding author
Brian C. J. Moore   

Psychology, University of Cambridge, Downing Street, CB2 3EB, Cambridge, United Kingdom
 
 
J Hear Sci 2025;1(SPECIAL ISSUE ON MISOPHONIA AND HYPERACUSIS 1):7-16
 
KEYWORDS
TOPICS
ABSTRACT
This paper is concerned with loudness hyperacusis, a condition where sounds of medium and high levels appear to be louder than normal. The “normal” perception of loudness can be understood using a model that takes into account the processing of sounds in the peripheral auditory system, including the outer ear, middle ear, and cochlea. This model has been modified to take into account the perception of loudness by people with cochlear hearing loss. The model predicts the loudness recruitment typically associated with cochlear hearing loss, and also predicts that hearing loss can sometimes be associated with “over-recruitment,” so that some sounds appear louder than normal. However, the model does not account for the fact that loudness hyperacusis can occur for people with normal or near-normal audiograms. This suggests that factors associated with higher levels in the auditory system also need to be taken into account. Here, two such factors are considered: the functioning of the efferent system regulating the active mechanism in the cochlea, and effects of central plasticity and adaptation. Both may play a role in hyperacusis.
FUNDING
This research and article did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
REFERENCES (99)
1.
ANSI. ANSI S1.1-2013. American National Standard Acoustical Terminology. New York: American National Standards Institute; 2013.
 
2.
Stevens SS. On the psychophysical law. Psych Rev, 1957; 64(3): 153–81. https://doi.org/10.1037/h00461....
 
3.
Hellman RP. Growth of loudness at 1000 and 3000 Hz. J Acoust Soc Am, 1976; 60(3): 672–9. https://doi.org/10.1121/1.3811....
 
4.
Tyler RS, Pienkowski M, Rojas Roncancio E, Jun HJ, Brozoski T, Dauman N, et al. A review of hyperacusis and future directions: part I. Definitions and manifestations. Am J Audiol, 2014; 23(4): 402–19. https://doi.org/10.1044/2014_A....
 
5.
Fowler EP. A method for the early detection of otosclerosis. Arch Otolaryngol, 1936; 24(6): 731–41. https://doi.org/10.1001/archot....
 
6.
Steinberg JC, Gardner MB. The dependence of hearing impairment on sound intensity. J Acoust Soc Am, 1937; 9(1): 11–23. https://doi.org/10.1121/1.1915....
 
7.
Moore BCJ. Testing the concept of softness imperception: loudness near threshold for hearing-impaired ears. J Acoust Soc Am, 2004; 115(6): 3103–11. https://doi.org/10.1121/1.1738....
 
8.
Khalfa S, Dubal S, Veuillet E, Perez-Diaz F, Jouvent R, Collet L. Psychometric normalization of a hyperacusis questionnaire. ORL J Otorhinolaryngol Relat Spec, 2002; 64(6): 436–42. https://doi.org/10.1159/000067....
 
9.
Greenberg B, Carlos M. Psychometric properties and factor structure of a new scale to measure hyperacusis: introducing the Inventory of Hyperacusis Symptoms. Ear Hear, 2018; 39(5): 1025–34. https://doi.org/10.1080/149920....
 
10.
Aazh H, Danesh A, Moore BCJ. Internal consistency and convergent validity of the Inventory of Hyperacusis Symptoms. Ear Hear, 2021; 42(4): 917–26. https://doi.org/10.1097/aud.00....
 
11.
Fowler EP. Some attributes of “loudness recruitment” and “loudness decruitment”. Ann Otol Rhinol Laryngol, 1965; 74(2): 500–6. https://doi.org/10.1177/000348....
 
12.
British Society of Audiology. Recommended procedure: determination of uncomfortable loudness levels. Reading, UK: British Society of Audiology; 2011.
 
13.
Sherlock LP, Formby C. Estimates of loudness, loudness discomfort, and the auditory dynamic range: normative estimates, comparison of procedures, and test–retest reliability. J Am Acad Audiol, 2005; 16(2): 85–100. https://doi.org/10.3766/jaaa.1....
 
14.
Knobel KA, Sanchez TG. [Loudness discomfort level in normal hearing individuals]. Pro Fono, 2006; 18: 31–40 [in Portuguese]. https://doi.org/10.1590/s0104-....
 
15.
Sheldrake J, Diehl PU, Schaette R. Audiometric characteristics of hyperacusis patients. Front Neurol, 2015; 6: 105. https://doi.org/10.3389/fneur.....
 
16.
Blaesing L, Kroener-Herwig B. Self-reported and behavioral sound avoidance in tinnitus and hyperacusis subjects, and association with anxiety ratings. Int J Audiol, 2012; 51(8): 611–7. https://doi.org/10.3109/149920....
 
17.
Anari M, Axelsson A, Eliasson A, Magnusson L. Hypersensitivity to sound: questionnaire data, audiometry and classification. Scand Audiol, 1999; 28(4): 219–30. https://doi.org/10.1080/010503....
 
18.
Aazh H, Moore BCJ. Factors related to uncomfortable loudness levels for patients seen in a tinnitus and hyperacusis clinic. Int J Audiol, 2017; 56(10): 793–800. https://doi.org/10.1080/149920....
 
19.
Meeus OM, Spaepen M, Ridder DD, Heyning PH. Correlation between hyperacusis measurements in daily ENT practice. Int J Audiol, 2010; 49(1): 7–13. https://doi.org/10.3109/149920....
 
20.
Fackrell K, Fearnley C, Hoare DJ, Sereda M. Hyperacusis Questionnaire as a tool for measuring hypersensitivity to sound in a tinnitus research population. Biomed Res Int, 2015; 2015: 290425. https://doi.org/10.1155/2015/2....
 
21.
Moore BCJ, Glasberg BR. A revision of Zwicker’s loudness model. Acta Acust United Acust, 1996; 82(2): 335–45.
 
22.
Moore BCJ, Glasberg BR, Baer T. A model for the prediction of thresholds, loudness and partial loudness. J Audio Eng Soc, 1997; 45: 224–40.
 
23.
Zwicker E, Scharf B. A model of loudness summation. Psych Rev, 1965; 72(1): 3–26. https://doi.org/10.1037/h00217....
 
24.
Glasberg BR, Moore BCJ. A model of loudness applicable to time-varying sounds. J Audio Eng Soc, 2002; 50(5): 331–42.
 
25.
Moore BCJ, Glasberg BR, Varathanathan A, Schlittenlacher J. A loudness model for time varying sounds incorporating binaural inhibition. Trends Hear, 2016; 20: 1–16. https://doi.org/10.1177/233121....
 
26.
Moore BCJ, Jervis M, Harries L, Schlittenlacher J. Testing and refining a loudness model for time-varying sounds incorporating binaural inhibition. J Acoust Soc Am, 2018; 143(3): 1504–13. https://doi.org/10.1121/1.5027....
 
27.
Shaw EAG. Transformation of sound pressure level from the free field to the eardrum in the horizontal plane. J Acoust Soc Am, 1974; 56(6): 1848–61. https://doi.org/10.1121/1.1903....
 
28.
Killion MC, Berger EH, Nuss RA. Diffuse field response of the ear. J Acoust Soc Am, 1987; 81: S75. https://doi.org/10.1121/1.2024....
 
29.
ISO 7029. Acoustics: Statistical distribution of hearing thresholds related to age and gender. Geneva: International Organization for Standardization; 2017.
 
30.
Aibara R, Welsh JT, Puria S, Goode RL. Human middle-ear sound transfer function and cochlear input impedance. Hear Res, 2001; 152(1–2): 100–9. https://doi.org/10.1016/S0378-....
 
31.
Pedersen CS, Møller H, Waye KP. A detailed study of low-frequency noise complaints. J Low Freq Noise Vib Active Cont, 2008; 27: 1–33. https://doi.org/10.1260/026309....
 
32.
Jurado C, Moore BCJ. Frequency selectivity for frequencies below 100 Hz: comparisons with mid-frequencies. J Acoust Soc Am, 2010; 128(6): 3585–96. https://doi.org/10.1121/1.3504....
 
33.
Jurado C, Pedersen CS, Moore BCJ. Psychophysical tuning curves for frequencies below 100 Hz. J Acoust Soc Am, 2011; 129(5): 3166–80. https://doi.org/10.1121/1.3560....
 
34.
Yasin I, Plack CJ. Psychophysical tuning curves at very high frequencies. J Acoust Soc Am, 2005; 118(4): 2498–506. https://doi.org/10.1121/1.2035....
 
35.
Moore BCJ, Glasberg BR. Suggested formulae for calculating auditory-filter bandwidths and excitation patterns. J Acoust Soc Am, 1983; 74(3): 750–3. https://doi.org/10.1121/1.4955....
 
36.
Glasberg BR, Moore BCJ. Derivation of auditory filter shapes from notched-noise data. Hear Res, 1990; 47(1–2): 103–38. https://doi.org/10.1016/0378-5....
 
37.
Moore BCJ. An Introduction to the Psychology of Hearing, 6th Ed. Leiden. The Netherlands: Brill; 2012.
 
38.
Ashmore JF. A fast motile response in guinea pig outer hair cells: the cellular basis of the cochlear amplifier. J Physiol, 1987; 388: 323–47. https://doi.org/10.1113/jphysi....
 
39.
Hudspeth A. Mechanical amplification of stimuli by hair cells. Curr Opin Neurobiol, 1997; 7(4): 480–6. https://doi.org/10.1016/s0959-....
 
40.
Ruggero MA. Responses to sound of the basilar membrane of the mammalian cochlea. Curr Opin Neurobiol, 1992; 2(4): 449–56. https://doi.org/10.1016/0959-4....
 
41.
Moore BCJ, Glasberg BR. A model of loudness perception applied to cochlear hearing loss. Br J Audiol, 1997; 3(3): 289–311.
 
42.
Moore BCJ, Glasberg BR. A revised model of loudness perception applied to cochlear hearing loss. Hear Res, 2004; 188(1–2): 70–88. https://doi.org/10.1016/S0378-....
 
43.
Dallos P. The active cochlea. J Neurosci, 1992; 12(12): 4575–85.
 
44.
Guinan JJ Jr, Backus BC, Lilaonitkul W, Aharonson V. Medial olivocochlear efferent reflex in humans: otoacoustic emission (OAE) measurement issues and the advantages of stimulus frequency OAEs. J Assoc Res Otolaryngol, 2003; 4(4): 521–40. https://doi.org/10.1007/s10162....
 
45.
Froud KE, Wong AC, Cederholm JM, Klugmann M, Sandow SL, Julien JP, et al. Type II spiral ganglion afferent neurons drive medial olivocochlear reflex suppression of the cochlear amplifier. Nature Commun, 2015; 6: 7115. https://doi.org/10.1038/ncomms....
 
46.
Guinan JJ Jr. Olivocochlear efferents: their action, effects, measurement and uses, and the impact of the new conception of cochlear mechanical responses. Hear Res, 2018; 362: 38–47. https://doi.org/10.1016/j.hear....
 
47.
Wicher A, Moore BCJ. Effect of broadband and narrowband contralateral noise on psychophysical tuning curves and otoacoustic emissions. J Acoust Soc Am, 2014; 135(5): 2931–41. https://doi.org/10.1121/1.4871....
 
48.
Liberman MC, Guinan JJ Jr. Feedback control of the auditory periphery: anti-masking effects of middle ear muscles vs. olivocochlear efferents. J Commun Disord, 1998; 31(6): 471–82. https://doi.org/10.1016/s0021-....
 
49.
Lauer AM, Jimenez SV, Delano PH. Olivocochlear efferent effects on perception and behavior. Hear Res, 2022; 419: 108207. https://doi.org/10.1016/j.hear....
 
50.
Micheyl C, Collet L. Involvement of the olivocochlear bundle in the detection of tones in noise. J Acoust Soc Am, 1996; 99(3): 1604–10. https://doi.org/10.1121/1.4147....
 
51.
Giraud AL, Garnier S, Micheyl C, Lina G, Chays A, Chery-Croze S. Auditory efferents involved in speech-in-noise intelligibility. Neuroreport, 1997; 8(7): 1779–83. https://doi.org/10.1097/000017....
 
52.
Maison SF, Liberman MC. Predicting vulnerability to acoustic injury with a noninvasive assay of olivocochlear reflex strength. J Neurosci, 2000; 20(12): 4701–7. https://doi.org/10.1523/jneuro....
 
53.
Maison SF, Luebke AE, Liberman MC, Zuo J. Efferent protection from acoustic injury is mediated via alpha9 nicotinic acetylcholine receptors on outer hair cells. J Neurosci, 2002; 22(24): 10838–46. https://doi.org/10.1523/jneuro....
 
54.
Sherrington CS. Further note on the sensory nerves of the eye-muscles. Proc Roy Soc, 1898; 64(402–411): 120–1. https://doi.org/10.1098/rspl.1....
 
55.
Helmholtz HLF. [A treatise on physiological optics]. Leipzig: Voss; 1863 [in German].
 
56.
Knudson IM, Shera CA, Melcher JR. Increased contralateral suppression of otoacoustic emissions indicates a hyperresponsive medial olivocochlear system in humans with tinnitus and hyperacusis. J Neurophysiol, 2014; 112(12): 3197–208. https://doi.org/10.1152/jn.005....
 
57.
Liu C, Glowatzki E, Fuchs PA. Unmyelinated type II afferent neurons report cochlear damage. Proc Natl Acad Sci USA, 2015; 112(47): 14723–7. https://doi.org/10.1073/pnas.1....
 
58.
Cope T, Baguley DM, Moore BCJ. Tinnitus loudness in quiet and noise after resection of vestibular schwannoma. Otol Neurotol, 2011; 32(3): 488–96. https://doi.org/10.1097/MAO.0b....
 
59.
Scharf B, Magnan J, Chays A. On the role of the olivocochlear bundle in hearing: 16 case studies. Hear Res, 1997; 103(1–2): 101–22. https://doi.org/10.1016/s0378-....
 
60.
Zeng FG, Martino KM, Linthicum FH, Soli SD. Auditory perception in vestibular neurectomy subjects. Hear Res, 2000; 142(1–2): 102–12. https://doi.org/10.1016/s0378-....
 
61.
Formby C, Sherlock LP, Gold SL. Adaptive plasticity of loudness induced by chronic attenuation and enhancement of the acoustic background. J Acoust Soc Am, 2003; 114(1): 55–8. https://doi.org/10.1121/1.1582....
 
62.
Florentine M. Relation between lateralization and loudness in asymmetrical hearing losses. J Am Audiol Soc, 1976; 1(6): 243–51.
 
63.
Butler RA. An analysis of the monaural displacement of sound in space. Percept Psychophys, 1987; 41(1): 1–7. https://doi.org/10.3758/bf0320....
 
64.
Hutchison P, Maeda H, Formby C, Small BJ, Eddins DA, Eddins AC. Acoustic deprivation modulates central gain in human auditory brainstem and cortex. Hear Res, 2023; 428: 108683. https://doi.org/10.1016/j.hear....
 
65.
Munro KJ, Blount J. Adaptive plasticity in brainstem of adult listeners following earplug-induced deprivation. J Acoust Soc Am, 2009; 126(2): 568–71. https://doi.org/10.1121/1.3161....
 
66.
Munro KJ, Trotter JH. Preliminary evidence of asymmetry in uncomfortable loudness levels after unilateral hearing aid experience: evidence of functional plasticity in the adult auditory system. Int J Audiol, 2006; 45(12): 684–8. https://doi.org/10.1080/149920....
 
67.
Keidser G, O’Brien A, Carter L, McLelland M, Yeend I. Variation in preferred gain with experience for hearing-aid users. Int J Audiol, 2008; 47(10): 621–35. https://doi.org/10.1080/149920....
 
68.
Salvi RJ, Wang J, Ding D. Auditory plasticity and hyperactivity following cochlear damage. Hear Res, 2000; 147(1–2): 261–74. https://doi.org/10.1016/s0378-....
 
69.
Auerbach BD, Rodrigues PV, Salvi RJ. Central gain control in tinnitus and hyperacusis. Front Neurol, 2014; 5: 206. https://doi.org/10.3389/fneur.....
 
70.
Roberts LE, Salvi R. Overview: hearing loss, tinnitus, hyperacusis, and the role of central gain. Neuroscience, 2019; 407: 1–7. https://doi.org/10.1016/j.neur....
 
71.
Zeng FG. Tinnitus and hyperacusis: central noise, gain and variance. Curr Opin Physiol, 2020; 18: 123–9. https://doi.org/10.1016/j.coph....
 
72.
Wake N, Shiramatsu TI, Takahashi H. Map plasticity following noise exposure in auditory cortex of rats: implications for disentangling neural correlates of tinnitus and hyperacusis. Front Neurosci, 2024; 18: 1385942. https://doi.org/10.3389/fnins.....
 
73.
Jastreboff PJ, Jastreboff MM. Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. J Am Acad Audiol, 2000; 11(3): 162–77. https://doi.org/10.1055/s-0042....
 
74.
Chen YC, Li X, Liu L, Wang J, Lu CQ, Yang M, et al. Tinnitus and hyperacusis involve hyperactivity and enhanced connectivity in auditory–limbic–arousal–cerebellar network. Elife, 2015; 4: e06576. https://doi.org/10.7554/eLife.....
 
75.
Shi L, Zhao R, Li X, Sun W, Liu X. A review of the neurobiological mechanisms that distinguish between loudness recruitment and hyperacusis. Med Sci Monit, 2022; 28: e936373. https://doi.org/10.12659/msm.9....
 
76.
Kujawa SG, Liberman MC. Adding insult to injury: cochlear nerve degeneration after “temporary” noise-induced hearing loss. J Neurosci, 2009; 29(45): 14077–85. https://doi.org/10.1523/jneuro....
 
77.
Stamper GC, Johnson TA. Auditory function in normal-hearing, noise-exposed human ears. Ear Hear, 2015; 36(2): 172–84. https://doi.org/10.1097/AUD.00....
 
78.
Liberman MC, Epstein MJ, Cleveland SS, Wang H, Maison SF. Toward a differential diagnosis of hidden hearing loss in humans. PLoS One, 2016; 11(9): e0162726. https://doi.org/10.1371/journa....
 
79.
Wu PZ, Liberman LD, Bennett K, de Gruttola V, O’Malley JT, Liberman MC. Primary neural degeneration in the human cochlea: evidence for hidden hearing loss in the aging ear. Neuroscience, 2019; 407: 8–20. https://doi.org/10.1016/j.neur....
 
80.
Wu PZ, O’Malley JT, de Gruttola V, Liberman MC. Age-related hearing loss is dominated by damage to inner ear sensory cells, not the cellular battery that powers them. J Neurosci, 2020; 40(33): 6357–66. https://doi.org/10.1523/jneuro....
 
81.
Wu PZ, O’Malley JT, Liberman MC. Neural degeneration in normal-aging human cochleas: machine-learning counts and 3D mapping in archival sections. J Assoc Res Otolaryngol, 2023; 24(5): 499–511. https://doi.org/10.1007/s10162....
 
82.
Sergeyenko Y, Lall K, Liberman MC, Kujawa SG. Age-related cochlear synaptopathy: an early-onset contributor to auditory functional decline. J Neurosci, 2013; 33(34): 13686–94. https://doi.org/10.1523/jneuro....
 
83.
Alvord LS. Cochlear dysfunction in “normal-hearing” patients with history of noise exposure. Ear Hear, 1983; 4(5): 247–50. https://doi.org/10.1097/000034....
 
84.
Hope AJ, Luxon LM, Bamiou DE. Effects of chronic noise exposure on speech-in-noise perception in the presence of normal audiometry. J Laryngol Otol, 2013; 127(3): 233–8. https://doi.org/10.1017/S00222....
 
85.
Holtegaard P, Olsen SO. Signs of noise-induced neural degeneration in humans. In: Individual Hearing Loss: Characterization, modelling, compensation strategies. Santurette S, Dau T, Dalsgaard JC, Tranebjærg L, Anderson T, Editors. Ballerup, Denmark: The Danavox Jubilee Foundation; 2016, pp. 117–24.
 
86.
Bramhall NF, McMillan GP. Perceptual consequences of cochlear deafferentation in humans. Trends Hear, 2024; 28: 23312165241239541. https://doi.org/10.1177/233121....
 
87.
Tremblay KL, Pinto A, Fischer ME, Klein BE, Klein R, Levy S, et al. Self-reported hearing difficulties among adults with normal audiograms: The Beaver Dam Offspring Study. Ear Hear, 2015; 36(6): e290–9. https://doi.org/10.1097/AUD.00....
 
88.
Moore BCJ, Sęk A, Vinay, Füllgrabe C. Envelope regularity discrimination. J Acoust Soc Am, 2019; 145(5): 2861–70. https://doi.org/10.1121/1.5100....
 
89.
Lowe D, Moore BCJ. Audiometric assessment of hearing loss sustained during military service. J Acoust Soc Am, 2021; 150(2): 1030–43. https://doi.org/10.1121/10.000....
 
90.
Fredriksson S, Hussain-Alkhateeb L, Torén K, Sjöström M, Selander J, Gustavsson P, et al. The impact of occupational noise exposure on hyperacusis: a longitudinal population study of female workers in Sweden. Ear Hear, 2022; 43(4): 1366–77. https://doi.org/10.1097/aud.00....
 
91.
Hickox AE, Liberman MC. Is noise-induced cochlear neuropathy key to the generation of hyperacusis or tinnitus? J Neurophysiol, 2014; 111(3): 552–64. https://doi.org/10.1152/jn.001....
 
92.
Liberman MC, Kujawa SG. Cochlear synaptopathy in acquired sensorineural hearing loss: manifestations and mechanisms. Hear Res, 2017; 349: 138–47. https://doi.org/10.1016/j.hear....
 
93.
Jahn KN, Hancock KE, Maison SF, Polley DB. Estimated cochlear neural degeneration is associated with loudness hypersensitivity in individuals with normal audiograms. JASA Express Lett, 2022; 2(6): 064403. https://doi.org/10.1121/10.001....
 
94.
McGill M, Hight AE, Watanabe YL, Parthasarathy A, Cai D, Clayton K, et al. Neural signatures of auditory hypersensitivity following acoustic trauma. eLife, 2022; 11: e80015. https://doi.org/10.7554/eLife.....
 
95.
Furman AC, Kujawa SG, Liberman MC. Noise-induced cochlear neuropathy is selective for fibers with low spontaneous rates. J Neurophysiol, 2013; 110(3): 577–86. https://doi.org/10.1152/jn.001....
 
96.
Parthasarathy A, Hancock KE, Bennett K, DeGruttola V, Polley DB. Bottom-up and top-down neural signatures of disordered multi-talker speech perception in adults with normal hearing. Elife, 2020; 9: e51419. https://doi.org/10.7554/eLife.....
 
97.
Schirmer J, Wolpert S, Dapper K, Rühle M, Wertz J, Wouters M, et al. Neural adaptation at stimulus onset and speed of neural processing as critical contributors to speech comprehension independent of hearing threshold or age. J Clin Med, 2024; 13(9): 2725. https://doi.org/10.3390/jcm130....
 
98.
Formby C, Cherri D, Secor CA, Armstrong S, Juneau R, Hutchison P, et al. Results of a 6-month field trial of a transitional intervention for debilitating hyperacusis. J Speech Lang Hear Res, 2024; 67(6): 1903–31. https://doi.org/10.1044/2024_j....
 
99.
Henry JA. Sound therapy to reduce auditory gain for hyperacusis and tinnitus. Am J Audiol, 2022; 31(4): 1067–77. https://doi.org/10.1044/2022_A....
 
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