The clatter of dishes. A child laughing in the next room. The hum of an air conditioner. For most people, these are background sounds their brain filters out automatically. But after a concussion, ordinary noises can feel unbearable.

If you've found yourself wincing at sounds that never bothered you before, or avoiding restaurants, grocery stores, and family gatherings because they feel overwhelmingly loud, you're not imagining things. Research shows that approximately 50% of people who sustain a concussion experience heightened sensitivity to sound, and for many, this symptom persists long after the initial injury.

This condition, known as hyperacusis or phonophobia, is one of the most common yet overlooked symptoms of post-concussion syndrome [link to: What is Post-Concussion Syndrome?]. It can dramatically affect your quality of life, making it difficult to work, socialize, or even relax in your own home. The good news? With the right treatment approach, most people can significantly reduce their noise sensitivity and return to normal activities.

At Cognitive FX, we've helped thousands of patients recover from persistent post-concussion symptoms, including noise sensitivity. We understand the neurological mechanisms behind this frustrating symptom and use evidence-based treatments to address the root causes, not just mask the symptoms.

What Is Hyperacusis? Understanding Noise Sensitivity After Brain Injury

Hyperacusis is a reduced tolerance to everyday sounds that most people find comfortable. After a concussion or traumatic brain injury (TBI), your brain's ability to process and filter auditory information can become disrupted. Sounds that should register as "normal" instead feel painfully loud, sharp, or intrusive.

This isn't the same as simply disliking loud noises. With hyperacusis, sounds at typical conversation volume (around 60 decibels) can feel as uncomfortable as standing next to a lawnmower. Your ears' dynamic range, meaning their ability to adapt to different volume levels, essentially shrinks.

It's important to distinguish hyperacusis from a related but different phenomenon: auditory sensory overload. With hyperacusis, sounds physically hurt or seem intolerably loud. With sensory overload, you struggle to separate sounds properly. Background noise forces itself into the foreground, making it impossible to focus on a single conversation or task. Many concussion patients experience both conditions simultaneously.

How Common Is Noise Sensitivity After Concussion?

Research paints a striking picture of how prevalent this symptom really is:

• Approximately 50% of concussion patients report sound sensitivity in the weeks following injury
• Studies show 59% of concussion patients experience some level of noise sensitivity
• Among those with severe TBI, 27% report persistent noise sensitivity at 12 months post-injury
• Nearly half of patients with auditory symptoms continue struggling beyond six years without proper treatment
• 80% of concussion patients who experience light sensitivity also experience sound sensitivity

These statistics highlight why noise sensitivity deserves more attention in concussion care. Too often, patients are told to simply rest and wait for symptoms to resolve. But when months or years pass without improvement, it's clear that a more active treatment approach is needed.

Why Does Sound Become Painful After a Concussion?

Understanding why your brain reacts this way can help you feel less frustrated and more empowered to seek effective treatment. Several neurological changes can contribute to post-concussion noise sensitivity.

Damage to Hair Cells in the Inner Ear

Your inner ear contains thousands of microscopic hair cells that convert sound vibrations into electrical signals for your brain. Think of these hair cells like blades of grass. When you step on grass, some blades spring back up while others remain flattened. The impact of a concussion can damage these delicate hair cells in a similar way.

Unlike grass, damaged hair cells cannot regrow or repair themselves. When they're injured, they may send distorted signals to your brain, causing sounds to seem louder, sharper, or more irritating than they should. This damage can also lead to tinnitus, the perception of ringing or buzzing when no external sound is present [link to: Tinnitus After Concussion].

Disrupted Auditory Processing in the Brain

Even when your ears function normally, the brain regions responsible for processing sound can malfunction after a head injury. The auditory cortex in your temporal lobe may become overactive, amplifying signals that should be dampened.

Research using functional imaging has shown that concussion patients often exhibit abnormal activity in the auditory cortex and connected limbic regions. This hyperactivity can make normal sounds feel overwhelming and exhausting to process.

Thalamus Dysfunction and Sensory Gating Impairment

One of the most significant contributors to post-concussion noise sensitivity involves the thalamus, a structure deep in the brain that acts as a sensory relay station. The thalamus filters incoming sensory information, deciding what deserves your attention and what should fade into the background.

Animal studies have shown that the thalamus is often damaged not by the initial impact but by secondary inflammation in the days and weeks following a concussion. When the thalamus isn't functioning properly, it loses its ability to gate sensory input. Instead of filtering out irrelevant background noise, everything floods through at full intensity.

This explains why many concussion patients describe feeling like they're in a room full of televisions, unable to focus their attention on any single source of sound. The brain's filter has essentially broken down.

Neurovascular Coupling Dysfunction

Your brain requires a constant supply of blood to function properly. Neurovascular coupling is the process by which active brain regions receive increased blood flow to meet their energy demands. After a concussion, this process can become impaired [link to: How Concussion Affects Blood Flow in the Brain].

When the auditory processing regions of your brain don't receive adequate oxygen and nutrients, they may malfunction and produce phantom sounds or exaggerated responses to normal sounds. This dysfunction is one reason why symptoms often worsen with fatigue or cognitive exertion.

Heightened Startle Reflex and Autonomic Dysregulation

Many TBI survivors develop an increased startle response, making sudden or loud sounds particularly distressing. This hypersensitivity relates to dysregulation of the autonomic nervous system, which controls your fight-or-flight response.

After a concussion, your nervous system may remain in a heightened state of alert, constantly scanning the environment for threats. Normal sounds get interpreted as potential dangers, triggering stress hormones and physical tension that make the experience even more unpleasant.

How Noise Sensitivity Affects Daily Life

The impact of sound sensitivity extends far beyond simple discomfort. It can fundamentally change how you navigate the world.

Social Isolation

Loud restaurants, crowded parties, busy malls, and even family gatherings can become overwhelming. Many patients describe retreating from social situations to avoid the assault of environmental noise. Over time, this isolation can contribute to depression, anxiety, and a diminished quality of life.

Workplace Challenges

Open-plan offices, ringing phones, chattering coworkers, and humming equipment can make concentration nearly impossible. Some patients find they can no longer tolerate their work environment, forcing career changes or reduced hours.

Difficulty with Communication

Paradoxically, noise sensitivity can impair your ability to understand speech. The brain struggles to isolate voices from background noise, making conversations in anything but quiet settings exhausting. You may find yourself asking people to repeat themselves constantly or avoiding phone calls altogether.

Sleep Disruption

Environmental sounds that previously went unnoticed, like a refrigerator humming or traffic outside, may now keep you awake or wake you repeatedly throughout the night. Poor sleep then worsens other post-concussion symptoms in a vicious cycle [link to: Sleep Problems After Concussion].

Anxiety and Hypervigilance

Living with noise sensitivity often creates anticipatory anxiety. You start dreading situations where loud sounds might occur, constantly scanning your environment for potential auditory threats. This hypervigilance is mentally exhausting and can lead to avoidance behaviors that increasingly limit your life.

The Connection Between Noise Sensitivity, Tinnitus, and Light Sensitivity

Noise sensitivity rarely occurs in isolation. It often appears alongside other sensory symptoms that share similar underlying mechanisms.

Tinnitus

Tinnitus, or the perception of ringing, buzzing, or humming sounds when no external source exists, frequently accompanies noise sensitivity after concussion. Both conditions involve abnormal activity in the auditory processing regions of the brain. If you experience tinnitus along with hyperacusis, addressing the underlying brain dysfunction becomes even more important.

Photophobia (Light Sensitivity)

Research consistently shows strong associations between noise and light sensitivity. One study found that 80% of concussed athletes who reported light sensitivity also reported sound sensitivity. Both may result from similar excitatory-inhibitory imbalances in the sensory cortices and from thalamus dysfunction.

If you're sensitive to bright lights, fluorescent lighting, or screens, the same treatment approaches that help with noise sensitivity often improve light sensitivity as well [link to: Light Sensitivity After Concussion].

Why Rest Alone Isn't Enough

The traditional advice for concussion recovery, rest in a dark, quiet room, can actually backfire when it comes to noise sensitivity.

While brief rest periods may help during the acute phase of recovery, prolonged isolation from normal sounds can make hyperacusis worse over time. Your brain may become even more sensitized to sound when you eventually try to return to normal activities. Extended time in dark, silent environments can essentially train your auditory system to overreact to normal stimuli.

This is why an active, structured approach to recovery typically produces better outcomes than simply waiting for symptoms to resolve on their own. The brain needs appropriate, graduated exposure to sounds to recalibrate its response thresholds.

Treatment Options for Post-Concussion Noise Sensitivity

Effective treatment for hyperacusis typically requires a multifaceted approach that addresses both the neurological dysfunction and the behavioral patterns that develop around sound avoidance.

Sound Desensitization Therapy

One of the most evidence-based approaches involves gradually reintroducing sounds to help your brain relearn how to process them without triggering a stress response. This works through the principle of neuroplasticity, your brain's ability to form new connections and adapt to new patterns.

The process typically involves:

• Starting with neutral sounds like white noise, nature sounds, or soft instrumental music at very low volumes
• Gradually increasing exposure duration and volume as tolerance improves
• Using consistent daily practice to reinforce new auditory processing patterns
• Progressing from controlled environments to real-world settings

Sound therapy can take several months, but research shows it effectively improves sound tolerance in most patients.

Filtered Earplugs and Assistive Devices

Unlike foam earplugs that block all sound, filtered earplugs (like those from Etymotic, Loop, or Vibes) reduce volume while preserving sound clarity. These can help you participate in activities that would otherwise be overwhelming while you work on long-term recovery.

Noise-canceling headphones can provide relief in particularly challenging environments but should be used strategically. Over-relying on any device that blocks sound can delay recovery by preventing the graduated exposure your brain needs.

Cognitive Behavioral Therapy

Psychological factors play a significant role in how debilitating noise sensitivity becomes. Fear avoidance, where you increasingly avoid sounds because you anticipate pain or discomfort, can worsen the condition over time.

Cognitive behavioral therapy (CBT) helps by:

• Addressing anxiety and catastrophic thinking about sounds
• Developing healthier coping strategies
• Reducing hypervigilance and the stress response
• Supporting gradual return to avoided activities

Research shows that combining sound therapy with CBT and relaxation techniques produces especially strong outcomes.

Vestibular and Physical Therapy

Noise sensitivity often co-occurs with vestibular dysfunction, including dizziness, balance problems, and motion sensitivity. Physical therapists trained in vestibular rehabilitation can incorporate habituation techniques that benefit both systems simultaneously.

These therapies may include:

• Gaze stabilization exercises
• Balance training
• Controlled exposure to movement and sensory stimulation
• Exercises that challenge the brain's sensory integration

Comprehensive Neurorehabilitation at Cognitive FX

At Cognitive FX, we take a different approach than most concussion clinics. Rather than treating each symptom in isolation, we address the underlying brain dysfunction that causes multiple symptoms, including noise sensitivity, to persist.

Our treatment process begins with a functional Neurocognitive Imaging (fNCI) scan, an advanced form of MRI that measures how well different regions of your brain communicate and function. This imaging reveals exactly which brain networks have been affected by your injury, allowing us to create a targeted treatment plan.

Our EPIC (Enhanced Performance in Cognition) treatment program combines multiple evidence-based therapies delivered by a coordinated team of specialists working together under one roof:

• Cognitive therapy to strengthen attention, processing speed, and executive function
• Physical therapy including vestibular rehabilitation and exercises that promote neurovascular coupling
• Sensorimotor therapy to help your brain better integrate sensory information
• Neurointegration therapy that addresses how different brain systems work together
• Psychological support to address anxiety, depression, and emotional regulation

Rather than spending months or years piecing together care from separate providers who never communicate, our patients receive intensive, coordinated treatment that produces measurable improvements. Published research shows that 77% of our patients experience meaningful symptom reduction, with 95% showing statistically verified restoration of brain function.

TMS Therapy for Auditory Symptoms

Transcranial magnetic stimulation (TMS) represents an emerging treatment option for persistent auditory symptoms, including tinnitus and noise sensitivity, that haven't responded to conventional approaches.

TMS uses magnetic fields to stimulate or inhibit specific brain regions. For auditory symptoms, treatment typically targets:

• The auditory cortex to reduce overactivity
• The prefrontal cortex to enhance the brain's ability to filter and suppress unwanted sounds
• The dorsolateral prefrontal cortex (DLPFC), which influences tinnitus awareness and annoyance

A meta-analysis of 29 randomized controlled trials involving over 1,200 patients found that repetitive TMS (rTMS) produced significant improvements in tinnitus severity at one week, one month, and six months post-treatment. Clinical studies suggest that over 50% of patients receiving TMS for auditory symptoms experience some improvement.

At Cognitive FX, we offer TMS therapy as part of our comprehensive treatment options. Using functional MRI guidance, we can precisely target the brain regions affected by your specific injury pattern, potentially improving outcomes compared to standard TMS protocols 

TMS is non-invasive, well-tolerated, and can be combined with other rehabilitation approaches for enhanced results.

What to Expect During Recovery

Recovery from post-concussion noise sensitivity follows different timelines for different patients, but understanding the general trajectory can help set realistic expectations.

Typical Recovery Stages

0-3 Months Post-Injury: For many patients, noise sensitivity is most intense during this period. Basic sound avoidance, white noise at night, and avoiding overwhelming environments may be appropriate while the acute injury heals.

3-6 Months: If symptoms persist beyond the expected recovery window, this is the time to pursue active treatment. Begin structured sound exposure therapy, experiment with filtered earplugs, and consider a comprehensive evaluation.

6-12 Months: With appropriate treatment, most patients see significant improvement during this period. Track your progress and adjust strategies as tolerance improves.

12+ Months: Full or substantial recovery is possible for most patients, though some may continue using coping tools in challenging situations. If symptoms remain debilitating at this point without treatment, a specialized program like Cognitive FX's EPIC treatment may help break through the plateau.

Factors That Influence Recovery

Several factors can affect how quickly you improve:

• Time since injury: Generally, the sooner treatment begins, the faster recovery occurs
• Severity of initial injury: More severe injuries may require more intensive intervention
• Presence of other symptoms: Noise sensitivity occurring alongside cognitive, emotional, or vestibular symptoms suggests broader brain dysfunction that benefits from comprehensive treatment
• Prior concussion history: Multiple concussions can extend recovery time
• Psychological factors: Anxiety and fear avoidance can prolong symptoms if not addressed
• Treatment approach: Active, multidisciplinary treatment typically produces faster results than passive waiting

When to Seek Specialized Help

Consider seeking evaluation from a concussion specialist if:

• Noise sensitivity persists beyond 3 months post-injury
• Symptoms are severe enough to interfere with work, relationships, or daily activities
• You've tried basic sound therapy without improvement
• You experience multiple post-concussion symptoms alongside noise sensitivity
• You're caught in cycles of avoidance that keep shrinking your world
• Standard medical evaluations haven't found a clear explanation

At Cognitive FX, we specialize in treating patients whose symptoms have persisted for months, years, or even decades after their injury. Our functional imaging allows us to see exactly how your brain has been affected and create a targeted treatment plan to address the root causes of your symptoms.

Practical Coping Strategies While You Heal

While pursuing treatment, these strategies can help you manage daily life:

Environmental modifications:

• Use soft furnishings, rugs, and curtains to absorb sound at home
• Consider white noise machines to create a consistent auditory background
• Plan activities during quieter times (early morning shopping, off-peak restaurants)

Communication strategies:

• Let friends and family know about your sensitivity so they can support you
• Choose quieter venues for social gatherings
• Take breaks during prolonged exposure to noise

Gradual exposure:

• Don't avoid all sound, as this can worsen sensitivity over time
• Practice brief, controlled exposure to moderately challenging sounds
• Gradually increase duration as you build tolerance

Stress management:

• Practice relaxation techniques that reduce autonomic nervous system activation
• Prioritize sleep, as fatigue worsens all sensory symptoms
• Address anxiety with appropriate professional support

Work accommodations:

• Request a quieter workspace if possible
• Use noise-canceling headphones strategically
• Take regular breaks in quiet spaces
• Consider flexible scheduling around high-noise periods

Taking the Next Step Toward Recovery

Noise sensitivity after concussion is a real, neurological condition with real solutions. You don't have to keep living in a world that feels too loud, avoiding the activities and people you love, or wondering if things will ever get better.

At Cognitive FX, we've helped thousands of patients recover from post-concussion symptoms that other providers couldn't resolve. Our approach combines advanced brain imaging, multidisciplinary treatment, and evidence-based therapies to address the root causes of your symptoms, not just manage them.

If noise sensitivity is affecting your quality of life, we encourage you to schedule a consultation to discuss your symptoms and learn whether our treatment approach is right for you. Recovery is possible, and you don't have to figure it out alone.

Prevalence & Statistics:

1. Assi, H., Moore, R.D., Ellemberg, D., & Hébert, S. (2018). Sensitivity to sounds in sport-related concussed athletes: A new clinical presentation of hyperacusis. Scientific Reports, 8(1), 9921. https://doi.org/10.1038/s41598-018-28312-1 (Source for 80% co-occurrence of light and sound sensitivity in athletes)
2. Callahan, M.L., & Lim, M.M. (2018). Sensory sensitivity in TBI: Implications for chronic disability. Current Neurology and Neuroscience Reports, 18(9), 56. https://doi.org/10.1007/s11910-018-0867-x
3. Landon, J., Shepherd, D., et al. (2012). Hearing every footstep: Noise sensitivity in individuals following traumatic brain injury. Brain Injury, 26(3). https://pubmed.ncbi.nlm.nih.gov/22292864/
4. van der Naalt, J., et al. (2023). Hypersensitivity to Noise and Light Over 1 Year After Mild Traumatic Brain Injury. Journal of Head Trauma Rehabilitation, 38(3). https://journals.lww.com/headtraumarehab/fulltext/2023/05000/hypersensitivity_to_noise_and_light_over_1_year.6.aspx (Source for 27% persistent noise sensitivity at 12 months in severe TBI)
5. Wijenberg, M.L.M., et al. (2021). Prevalence of Post-Concussion-Like Symptoms in the General Injury Population. International Journal of Environmental Research and Public Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922247/

Mechanisms & Neuroscience:

6. Theodoroff, S.M., et al. (2021). Concussion Management Guidelines Neglect Auditory Symptoms. American Journal of Audiology, 30(1). https://pmc.ncbi.nlm.nih.gov/articles/PMC7956904/ (Key source for auditory symptoms being overlooked in concussion care)
7. Shepherd, D., Landon, J., Kalloor, M., et al. The association between health-related quality of life and noise or light sensitivity in survivors of a mild traumatic brain injury. Quality of Life Research.

TMS Research:

8. Liang, Z., et al. (2020). Repetitive transcranial magnetic stimulation on chronic tinnitus: A systematic review and meta-analysis. BMC Psychiatry, 20(1), 547. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02947-9 (Source for meta-analysis of 29 RCTs with 1,228 patients)
9. Lefaucheur, J.P., et al. (2023). Unresolved Issues Associated with Transcranial Magnetic Stimulation (TMS) Treatment of Chronic Tinnitus. Brain Sciences. https://pmc.ncbi.nlm.nih.gov/articles/PMC10380975/
10. Piccirillo, J.F., et al. (2021). Implications of Transcranial Magnetic Stimulation as a Treatment Modality for Tinnitus. Frontiers in Neurology. https://pmc.ncbi.nlm.nih.gov/articles/PMC8622674/

Clinical Guidelines & Treatment:

11. Mayo Clinic Health System. (2024). Don't miss a quiet symptom of concussion. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/dont-miss-a-quiet-symptom-of-concussion
12. Flint Rehab. (2025). Hyperacusis After TBI: Causes and Treatment to Deal With Sensitivity to Sound. https://www.flintrehab.com/hyperacusis-after-tbi/
13. American Occupational Therapy Association. (2024). Managing noise sensitivity in clients with post-concussion syndrome. OT Practice.
14. Bumgardner, T.M. (2017). Postconcussive Syndrome (PCS) Clinical Practice Guideline: Occupational Therapy. The Ohio State University Wexner Medical Center. https://medicine.osu.edu/-/media/files/medicine/departments/sports-medicine/medical-professionals/concussionot.pdf

Additional Supporting Sources:

15. BrainLine. (2018). Recovering from Mild Traumatic Brain Injury. https://www.brainline.org/article/recovering-mild-traumatic-brain-injury
16. Brain Injury Explanation. Hyperacusis: Invisible consequences of brain injury. https://www.braininjury-explanation.com/consequences/invisible-consequences/hyperacusis
17. PTSD UK. Hyperacusis and PTSD. https://www.ptsduk.org/hyperacusis-and-ptsd/