The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. Persistent sensory symptoms after concussion warrant assessment by the appropriate specialist, an audiologist or ENT for hearing and sound symptoms, a neuro-optometrist or ophthalmologist for visual and eye symptoms, and a physician or neurologist to coordinate care. Consult a concussion-experienced clinician for individualized care. Hyperacusis persists after concussion because the injured brain turns up the gain of the central auditory system, so ordinary sounds are perceived as uncomfortably or painfully loud (Ashina et al., 2019). Hyperacusis is reduced tolerance to everyday sound at levels that do not bother other people. After concussion it reflects increased central auditory gain, the brain amplifying sound signals as part of its general sensitized, hyperexcitable state, rather than damage to the ear itself. Overprotecting the ears with constant earplugs deepens the sensitivity by pushing the gain even higher. Recovery comes from graded sound exposure and sound therapy that retrain the auditory system to accept normal input, alongside autonomic regulation, rather than from silence and avoidance. Hyperacusis is reduced tolerance to everyday sound levels. The injured brain amplifies sound by raising central auditory gain. Graded sound exposure retrains the system, and overprotection worsens it. What Hyperacusis Is Hyperacusis is an abnormally reduced tolerance to ordinary environmental sounds. Everyday noises, running water, dishes clattering, conversation, traffic, a child's voice, are perceived as too loud, harsh, or even painful at intensities that others find perfectly comfortable. It is different from a fear of sound and from ordinary annoyance. In hyperacusis the sound genuinely feels physically too loud, and it can provoke discomfort, ear pain, headache, and a strong urge to escape the noise. Hyperacusis often coexists with tinnitus and with the broader sensory sensitivity of concussion, and it frequently overlaps with phonophobia, the aversion to sound, and misophonia, the emotional reaction to specific sounds. These are distinct but related, and a person can have more than one at once. How Concussion Raises Central Auditory Gain Hearing is not passive. The central auditory system, the brainstem and cortical pathways that process sound after it leaves the ear, applies gain, adjusting how strongly sound signals are amplified. Concussion disturbs the balance of excitation and inhibition in these pathways, reducing inhibition and raising the gain. The brain effectively turns up the volume on all incoming sound, so signals that should be comfortable are amplified into discomfort. This is part of the general sensitized state after concussion, the same lowered threshold that produces light sensitivity and other sensory symptoms, expressed in the auditory system. Because the problem is central gain rather than ear damage, hearing tests are often normal even while sounds feel unbearable, which can be confusing without understanding the mechanism. Why Overprotection Makes It Worse The instinct with painful sound is to protect the ears, and many people wear earplugs constantly or retreat into silence. This backfires. When the auditory system receives less sound input, it compensates by raising the gain even further to detect the quieter world, so tolerance narrows and the next exposure feels louder still. Constant ear protection therefore deepens hyperacusis over time. Ear protection has a place for genuinely loud environments, but continuous use in ordinary settings is counterproductive and sustains the sensitivity it is meant to relieve. Symptom Presentation Ordinary sounds perceived as too loud, harsh, or painful Discomfort or ear pain from everyday noise Startling and flinching at normal sounds Headache and fatigue provoked by noisy environments A strong urge to escape or protect against sound Normal hearing tests despite the intolerance Frequent coexisting tinnitus and light sensitivity Assessment An audiologist assesses hyperacusis with hearing tests and measures of loudness discomfort, the level at which sound becomes uncomfortable, which is reduced in hyperacusis even when hearing thresholds are normal. The assessment distinguishes hyperacusis from phonophobia and misophonia, which coexist but need different emphasis, and identifies coexisting tinnitus. A physician or neurologist considers the broader post-concussion picture, since hyperacusis usually travels with other sensory and autonomic symptoms. Treatment Approach Sound therapy and graded exposure are the core treatments, because they retrain the central gain. Rather than silence, the auditory system is given controlled, comfortable sound, often low-level background sound, and exposure is gradually broadened as tolerance grows. This teaches the system to lower its gain again. Tinnitus retraining therapy and related structured programs, delivered by an audiologist, apply this principle systematically. Reducing overprotection is essential. Ear protection is reserved for genuinely loud environments and used strategically rather than continuously, so the system is not starved of the normal input it needs to recalibrate. Autonomic regulation through diaphragmatic breathing lowers the sympathetic arousal that amplifies sensitivity, and treating coexisting headache and protecting sleep raise sound tolerance. As the brain recovers, central gain settles and hyperacusis generally improves, with sound therapy speeding the process. Sensory symptoms after concussion improve faster when the nervous system is regulated and the neck and autonomic system are addressed alongside specialist care. Start your 3-day free trial to build a supportive daily routine. Supporting Mobility Routine JME 155 Diaphragmatic breathing lowers the sympathetic drive that amplifies sensory sensitivity and steadies the nervous system. Ten slow breaths, several times daily. JME 14 Chin tucks reduce upper cervical tension that feeds headache, dizziness, and sensory overload. Ten repetitions with 5-second holds. JME 1 Cervical rotation restores segmental mobility and supports blood flow through the vertebral arteries to the brain. Ten repetitions per direction. JME 15 Cervical lateral flexion addresses side-bending restriction that sustains neck tension and sensory strain. Ten repetitions per side. JME 16 Cervical flexion and extension restore sagittal mobility restricted by suboccipital guarding. Eight slow repetitions. JME 2 Cervical retraction reinforces a neutral head position that reduces the postural strain feeding sensory symptoms. Ten repetitions per set. JME 150 Thoracic rotation restores mid-back motion needed for full diaphragmatic breathing and relaxed upright posture. Eight repetitions per direction. JME 227 Overhead reach opens the thoracic spine and rib cage, supporting the deep breathing that calms an overloaded nervous system. Ten repetitions with controlled tempo. Start your 3-day free trial for joint-specific mobility programming that supports the nervous system regulation behind sensory recovery after concussion. Common Mistakes Wearing earplugs constantly, which raises central gain and worsens sensitivity Retreating into silence instead of using graded sound exposure Assuming normal hearing tests mean the symptom is not real Leaving coexisting headache and poor sleep untreated Confusing hyperacusis with misophonia and applying the wrong emphasis Progression Assessment measures loudness discomfort and separates hyperacusis from related sound symptoms. Sound therapy and graded exposure retrain the central gain while overprotection is reduced. Autonomic regulation, headache treatment, and sleep support raise tolerance. Hyperacusis generally improves over weeks to months as central gain settles, with structured sound therapy accelerating recovery. What is hyperacusis after a concussion? Hyperacusis is reduced tolerance to everyday sounds, which are perceived as too loud, harsh, or painful at levels others find comfortable. After concussion it reflects increased central auditory gain, the brain amplifying sound as part of its sensitized state, rather than ear damage, which is why hearing tests are often normal. Why do normal sounds hurt my ears after a concussion? The central auditory system raises its gain after injury, turning up the amplification of all incoming sound. Reduced inhibition in the auditory pathways means comfortable sound levels are amplified into discomfort or pain. The ear itself is usually undamaged, so the problem is how the brain processes sound rather than how the ear detects it. Should I wear earplugs for hyperacusis? Only strategically, for genuinely loud environments. Constant earplug use starves the auditory system of normal input, so it raises the gain further and tolerance narrows, deepening hyperacusis over time. Graded sound exposure, not silence, retrains the system, so continuous ear protection in ordinary settings is counterproductive. Will hyperacusis go away after a concussion? Generally it improves over weeks to months as the brain recovers and central gain settles. Sound therapy and graded exposure speed recovery, while overprotection slows it. Persistent hyperacusis warrants assessment by an audiologist for structured sound therapy such as tinnitus retraining therapy. How is hyperacusis different from misophonia? Hyperacusis is a general intolerance in which ordinary sounds feel physically too loud. Misophonia is a strong emotional reaction to specific trigger sounds, such as chewing, regardless of their loudness. They coexist after concussion but differ in mechanism and emphasis, so an accurate assessment guides the right treatment. Why Sensory Symptoms Happen After Concussion Sensory symptoms after concussion arise from disrupted sensory processing rather than damage to the sense organs alone. Concussion strains the connections between brain regions, alters the balance of excitation and inhibition, and leaves the nervous system in a sensitized, hyperexcitable state (Silverberg et al., 2020). In this state the brain turns up the gain on incoming signals, so ordinary light, sound, smell, taste, and touch are amplified, distorted, or perceived when absent. Some symptoms also reflect direct injury to sensory nerves. Most sensory symptoms improve over weeks to months as the brain recovers and the gain settles, and structured management speeds the process. Graded Exposure and Avoiding Overprotection A common trap in sensory recovery is total avoidance. Completely shielding from light, sound, or activity feels protective, but sustained avoidance makes the nervous system more sensitive over time, narrowing tolerance further. The better approach is graded exposure: staying within a tolerable range while gradually and deliberately increasing exposure as tolerance grows, never pushing far past the point where symptoms flare. This retrains the nervous system to accept normal sensory input. Extreme protection, such as constant dark glasses indoors or continuous earplug use, tends to worsen sensitivity and is used sparingly and strategically rather than continuously. Managing Sensory Overload Reduce competing sensory input by handling one channel at a time Take planned breaks in a calm, low-stimulation environment before overload builds Use diaphragmatic breathing to lower the arousal that amplifies sensitivity Pace demanding sensory environments rather than avoiding them entirely Protect sleep, since fatigue lowers sensory tolerance Treat coexisting headache, since pain and sensory sensitivity feed each other When to Seek Specialist Assessment Persistent or worsening sensory symptoms, symptoms that interfere with work or daily life, and any symptom with concerning features warrant specialist assessment. Hearing and sound symptoms are evaluated by an audiologist or ENT, who can test hearing and guide sound therapy. Visual and eye symptoms are evaluated by a neuro-optometrist or ophthalmologist. Smell and taste symptoms are evaluated by an ENT. A physician or neurologist coordinates care and excludes other causes. Pulsatile tinnitus, sudden vision or hearing loss, and rapidly worsening symptoms need prompt evaluation rather than watchful waiting. The Autonomic and Cervical Contribution Sensory symptoms rarely stand alone after concussion. Autonomic dysregulation keeps the nervous system in a heightened, sympathetic-dominant state that amplifies sensitivity, and cervical dysfunction feeds headache, dizziness, and sensory strain through shared brainstem pathways. Regulating the autonomic nervous system with diaphragmatic breathing and graded activity, and addressing the neck with mobility and manual therapy, lower the background arousal on which sensory symptoms ride. This is why calming the nervous system as a whole often eases sensory symptoms that specialist treatment alone does not fully resolve. References Ashina, H., et al. (2019). Post-traumatic headache: epidemiology and pathophysiological insights. Nature Reviews Neurology, 15(10), 607-617. PubMed Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed Silverberg, N. D., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393. PubMed