Decreased Sound Tolerance: A Summary

Decreased sound tolerance is when people have a negative reaction to sound. People are most familiar with hyperacusis. But there are 3 types of decreased sound tolerance: hyperacusis, misophonia, and phonophobia.

Hyperacusis is from hyperactivity in the hearing system so the person hears sound extra loud that other people don’t hear as loudly. Sound hurts. Like jabbing needles through your eardrums. Sometimes all sound hurts, no matter the pitch or frequency. Sometimes only certain sounds hurt, like a fork scraping on a plate, dishes clattering, a balloon popping, or ambulance siren. People of any age can have hyperacusis.

The second type of decreased sound tolerance is misophonia. Misophonia is hate of specific sounds, like chewing, teeth sucking, whistling, or people tapping on the keyboard of their phone while texting. The main symptom is being filled with intense rage, possibly including murderous thoughts, when the person hears the sound.

Phonophobia is the third type of decreased sound tolerance. Phonophobia is fear of specific sounds, like an air horn, balloon pop, or unexpected bang.  The fear and anxiety typically gets worse when the person is anticipating the sound is going to happen. Phonophobia is sometimes called irrational fear, when it’s for sounds not expected to cause anxiety. Symptoms can include feelings of panic, terror, or dread, rapid heartbeat, nausea, dry mouth, and trembling.

People can have one or more types of decreased sound tolerance, depending on the individual. Hyperacusis was first identified in the 1980’s-1990’s by neurologist Dr. Pawel Jastreboff and audiologist Dr. Jonathan Hazell. Over the years, there has been more and more science on hyperacusis, misophonia, and phonophobia. There is still more to learn on understanding and treating these conditions.

Based on Hall, J.W. (2013, Mar 4). 20Q: Treating patients with hyperacusis and other forms of decreased sound tolerance. Audiology Online. Retrieved from

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