The intervention, known as Auditory Object Identification and Localisation (AOIL) training, is built on a striking idea: that hyperacusis is not just a problem of the ear, but of how the brain organises the acoustic world. Auditory scene analysis, a concept pioneered by psychologist Albert Bregman, describes the auditory system’s ability to parse a chaotic soundscape into distinct objects and streams—separating a friend’s voice from the babble of a busy room. The training targets exactly this skill, along with selective auditory attention, through two game-like exercises called Sound Locator and Sound Identifier.

In Sound Locator, participants memorise a target sound—perhaps a splash or a metallic rattle—then must pick out its spatial location from six options while ignoring competing sounds and background audio. Sound Identifier raises the difficulty: three environmental sounds are played in sequence, and participants answer questions such as “What did you hear on your right?” or “Where did you hear the metal impact?” The tasks demand active engagement with acoustic information, distinguishing them from the passive listening approaches that dominate current hyperacusis treatments, which typically rely on gradual sound exposure and desensitisation.

The sixteen participants, aged 21 to 72 and mostly women, were screened with the Inventory of Hyperacusis Symptoms, with a mean score of 73.2 confirming clinically significant symptoms. Eleven also had tinnitus. The condition’s toll was severe: fourteen of sixteen reported that hyperacusis interfered with social activities, twelve with family activities, and all sixteen said it harmed their work performance and concentration. Nine found normal conversational speech excessively loud. None had previously received treatment for hyperacusis.

Before and after the fourteen-day training period, the researchers measured three outcomes capturing different dimensions of the disorder. Loudness Discomfort Levels (LDLs) gauge how loud a tone must be before it becomes intolerable. Acceptable Noise Levels (ANLs) quantify the maximum background noise a listener will accept while following speech. The Noise Sensitivity Questionnaire (NoiSeQ) captures self-reported reactions to environmental noise across leisure, work, communication, habitation, and sleep.

The results were consistent across all three measures. Mean LDLs rose from 64.45 to 73.91 dB HL—an average gain of nearly 9.5 dB that held across all tested frequencies and both ears, with no frequency-specific pattern. Because previous research suggests people with hyperacusis average roughly 13 dB lower LDLs than controls, the improvement, if it generalises, would push participants close to normal loudness perception. Notably, earlier AOIL studies in people with normal sound tolerance found no LDL changes, likely because their baselines left little room to improve—hinting the training may be most valuable when tolerance is abnormally reduced.

The ANL findings were equally compelling. Participants’ most comfortable listening level for speech stayed stable, but the background noise level they were willing to accept jumped from 33.4 to 39.1 dB, driving the ANL down from 18.7 to 12.6 dB—a 6.1 dB improvement with a large effect size, with roughly 54 percent of the variance in ANL scores attributable to the intervention. The pattern is telling: the gain came from increased willingness to tolerate competing noise, not from any shift in preferred speech levels, which aligns precisely with the attentional and scene-analysis processes the training was designed to engage. NoiSeQ scores also fell by about 11 points, a moderate-to-large effect suggesting participants genuinely perceived themselves as less sensitive to everyday noise.

Adherence was high, with participants completing an average of 11.8 of the prescribed 14 training days, and older participants were notably more consistent than younger ones. Intriguingly, age showed the opposite relationship with outcomes: younger participants achieved larger gains in loudness tolerance, which the authors suggest may reflect differences in auditory plasticity or responsiveness to perceptual training. Improvements in ANL correlated moderately with reductions in NoiSeQ scores, hinting that the behavioural and subjective measures were converging on the same underlying change.

The authors propose two mechanisms that may not be mutually exclusive. Training may sharpen attentional control, enabling people with hyperacusis to filter, organise, and interpret auditory information more effectively, reducing the impact of environmental sounds. Alternatively, repeated exposure to a wide range of sounds during training may have produced a form of controlled desensitisation, or shifted how sounds are judged relative to an internal reference norm. Either way, the findings challenge the view of noise sensitivity as a fixed personality trait, suggesting instead a dynamic interaction between auditory processing, attention, emotion, and context—one that rehabilitation can influence.

Important caveats remain. The study was small, lacked a control group, and cannot rule out placebo effects, expectation effects, or natural symptom fluctuations. The senior author is a founder of TrueSilence Therapeutics, which developed the QCore platform used in the study, and the authors themselves call for independent, controlled, and blinded replication. Still, the combination of objective and subjective improvements from a brief, accessible, home-based intervention is a striking proof of concept. If larger trials confirm the effect, a twenty-minute daily game could become a genuine adjunct to counselling, sound therapy, and cognitive behavioural therapy—offering hope to the many patients for whom hyperacusis has long felt untreatable.

Subject of Research: Neuroscience

Article Title: Auditory object identification and localisation training for hyperacusis: preliminary effects on sound tolerance and noise acceptance

Article References: Aljoj, S., & Searchfield, G. D. (2026). Auditory object identification and localisation training for hyperacusis: preliminary effects on sound tolerance and noise acceptance. Frontiers in Human Neuroscience, 20, Article 1983358. https://doi.org/10.3389/fnhum.2026.1983358

Image Credits: AI Generated

DOI: 10.3389/fnhum.2026.1983358

Keywords: hyperacusis, auditory training, neuroscience, hearing, sound tolerance, brain training, tinnitus, Auditory, object, identification, localisation, training