Sound Sensitivity in Children: Looking Beyond Noise-Cancelling Headphones

Could there be an underlying hearing difficulty?

When a child regularly covers their ears, avoids noisy environments or becomes distressed by particular sounds, it can be easy to assume that the difficulty is entirely sensory. However, this is not always the case. An underlying hearing condition may be contributing to the child's experience.

Glue ear and fluctuating hearing

One example is glue ear, medically known as otitis media with effusion.

Glue ear is common in childhood and occurs when fluid builds up behind the eardrum. It can cause temporary or fluctuating hearing loss, making sounds less clear and listening more effortful.

Some children may experience increased sound sensitivity when their hearing improves following a period of glue ear. Sounds that were previously reduced or muffled may suddenly seem unusually loud.

The NHS recognises this relationship between glue ear and sound sensitivity. Glue ear can also affect a child's ability to follow conversations, particularly in noisy environments such as classrooms.

The National Institute for Health and Care Excellence (NICE) recommends that children with suspected glue ear receive appropriate assessment, including hearing testing and tympanometry.

Other conditions, including permanent hearing loss, tinnitus and certain medical conditions, may also contribute to difficulties with sound.

Noise-cancelling headphones: helpful support or potential barrier?

Noise-cancelling headphones and ear defenders are increasingly used to help children manage overwhelming sounds, particularly within educational settings.

And understandably so. For a child who is distressed by noise, reducing the amount of sound reaching their ears may offer immediate relief. Headphones may help a child remain in the classroom, participate in activities or manage environments that would otherwise feel overwhelming.

However, there are several important considerations when they become a child's main strategy for managing everyday sound.

1. Access to communication and learning

When we reduce environmental sound, we may also reduce access to important speech and communication.

Depending on the type of device and how it is used, children wearing headphones or ear defenders may find it more difficult to hear their teacher, follow conversations or respond to classmates.

Passive ear defenders reduce sound through physical attenuation, whereas active noise-cancelling headphones use technology to reduce certain environmental sounds. Their effects on speech access vary considerably.

Although a child may appear calmer and more settled, it is important to consider whether they remain fully included in the communication taking place around them.

2. Could prolonged sound avoidance increase sensitivity?

Another consideration is the potential effect of consistently reducing exposure to everyday sounds.

For individuals with hyperacusis, prolonged or unnecessary use of hearing protection in ordinary, safe listening environments may contribute to increased sound sensitivity.

NHS guidance advises against wearing earplugs or ear defenders continuously for hyperacusis, while recognising that short-term use can be beneficial in particularly noisy situations.

However, it is important not to generalise this advice to every child with sensory processing differences. Research examining the long-term effects of noise-cancelling headphones in neurodivergent children remains limited.

We cannot assume that headphone use will inevitably worsen sound sensitivity. For some children, sensory accommodations are essential to their comfort, wellbeing and ability to participate. The important consideration is whether headphones are being used thoughtfully as part of an individualised support plan, rather than becoming the only approach offered.

3. Are we addressing the underlying difficulty?

Providing headphones may help reduce the immediate sensory demands placed on a child. However, it does not necessarily explain why that child is struggling.

• Could there be fluctuating hearing levels?
• Is the child finding it difficult to understand speech in background noise?
• Are particular sounds causing physical discomfort or anxiety?
• Could the classroom environment be contributing to the difficulty?
• Or does the child experience broader sensory processing differences that require additional support?

Exploring these questions allows us to develop a more meaningful understanding of the child's needs.

The importance of collaboration between audiologists and occupational therapists

Sound sensitivity can involve both auditory and broader sensory factors, making collaboration between professionals particularly valuable.

Occupational therapists bring specialist expertise in sensory processing, regulation, participation and environmental adaptations.

Audiologists contribute expertise in hearing, middle-ear function, sound tolerance and auditory listening difficulties.

When a child presents with persistent sound sensitivity, communication between occupational therapists and audiologists may help identify underlying hearing-related factors alongside sensory needs.

Similarly, when an audiologist identifies broader sensory processing concerns, referral to occupational therapy may provide valuable additional insight.

Teachers, speech and language therapists, psychologists and families also play important roles in understanding how these difficulties affect everyday life.

By encouraging reciprocal referrals and shared management plans, we can develop more individualised support that considers the whole child. The goal is not simply to reduce sound exposure, but to promote comfort, communication, participation and inclusion.

A message to parents, teachers and professionals

If you are supporting a child who struggles with everyday sounds, the steps you take to help them feel safe and comfortable are incredibly valuable.

Noise-cancelling headphones can be a helpful accommodation, particularly when a child is distressed or overwhelmed. However, they should ideally form part of a wider, individualised approach rather than automatically becoming the only solution.

We would encourage families and professionals to consider a hearing assessment when a child experiences persistent sound sensitivity, particularly if they also have a history of ear problems, difficulty following conversations or concerns about their listening skills.