'It Seems Like I Hear Everything at Once'

Auditory sensory gating and neuropsychiatry.

Posted September 8, 2025 | Reviewed by Michelle Quirk

“It seems like I hear everything at once.”

This quote is from the Sensory Gating Inventory (SGI), a tool that captures the lived experience of sensory processing disorders from a patient’s perspective. These align with neurophysiological evidence of altered sensory processing, and more than half of the items concern hearing-related symptoms.

Impaired auditory gating is seen in a variety of neurological conditions, including schizophrenia, attention -deficit/hyperactivity disorder ( ADHD ), dementia , and others. These disruptions are precognitive and can predispose to behavioral traits such as distractibility, anxiety , avoidance, or irritability.

This is because the hierarchy of salience collapses when sensory gating is impaired. Every input, no matter how trivial, forces its way into awareness; everything is urgent, everything is foreground, everything is loud.

The Phenomenology of Impaired Sensory Gating

Imagine being in a crowded café with a friend. Your brain notices the clinking of cups, the hiss of the espresso machine, the laughter three tables over. However, it also easily suppresses these sounds, so you can focus on your friend.

Now imagine that every sound stays at full volume . The espresso machine's hiss and the laughter keep intruding. Even the scrape of a chair demands attention. Nothing recedes into the background, and you feel flooded by sounds . If this is what impaired sensory gating feels like, consider how profoundly it must shape mood and behavior.

Other auditory gating statements on the SGI include [1]:

The following describes how auditory gating deficits may appear in various conditions.

Schizophrenia is the most studied model of impaired sensory gating, with patients consistently being overwhelmed by auditory information. This deficit contributes to intrusive noise, fragmented cognition , and difficulty sustaining attention.

Attention-Deficit/Hyperactivity Disorder

In ADHD, background sounds intrude with unusual force, making sustained focus in classrooms, offices, or social situations especially difficult. These problems stem less from disposition than from impaired filtering of auditory input.

Alzheimer’s disease and related dementias frequently show impaired sensory gating. These deficits contribute to confusion, memory lapses, and difficulty prioritizing information.

In migraine , sensory overload is a defining feature, often extending beyond pain to light, sound, and motion. This is a good example of how sensory gating can fluctuate based on excitation-inhibition imbalances in neurotransmitters.

Tinnitus severity is tightly linked to deficits in sensory gating. People with normal gating can easily ignore the ringing sound, but those with impaired gating experience it as intrusive, distracting, and emotionally taxing.

A wide range of additional disorders also exhibit auditory gating deficits, underscoring their cross- cutting relevance. While each has distinct features, all converge on impaired filtering as a core mechanism.

Multimodal Treatment Is Key

Sensory gating is a complex phenomenon. At the micro level, neurotransmitter balance determines how effectively signals are gated, while at the macro level, coordinated brain networks determine whether sounds are dampened, prioritized, or emotionally amplified.

Because of this complexity, the optimal treatment approach is multimodal. No single intervention can restore balance across neurotransmitters, cortical networks, and emotional circuits alone. Instead, targeted strategies should work in parallel.

Here are some of the interventions for impaired sensory gating used at our tinnitus clinic :

Sensory gating is well studied, but we are only now beginning to understand its contribution to certain neurological conditions. Three takeaways stand out:

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Mohebbi M, Farhadi M, Daneshi A, Mahmoudian S. Toward An Exploration of Habituating to Tinnitus: Perspectives on Sensory Gating. J Am Acad Audiol. 2019 Nov/Dec;30(10):896–903. doi: 10.3766/jaaa.18038. Epub 2019 Jul 12. PMID: 31304914.

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Hamid Djalilian, M.D., is a professor of otolaryngology, neurosurgery, and biomedical engineering and Director of Otology and Neurotology at the University of California, Irvine and Chief Medical Advisor at NeuroMed Tinnitus Clinic.

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