Phonophobia

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This article is about the fear of specific sounds. For negative emotional reactions to specific sounds, such as eating, coughing, or alarms, see Misophonia. For the fear of making or taking phone calls, see Telephone phobia.
Phonophobia
Other namesLigyrophobia, sonophobia, acousticophobia,[1] fear hyperacusis[2][3]
A firecracker exploding
SpecialtyPsychiatry, neurology

Phonophobia, also called ligyrophobia or sonophobia, is a fear of or aversion to specific sounds—a type of specific phobia.[4] Occasionally it is called acousticophobia.[1] Although some sounds could be feared by most people, such as certain loud sounds or sounds that signal threats, fears of these sounds would not be considered phonophobia unless the amount of fear and anxiety was disproportionate.[3][4] In phonophobia, the feared sounds may be ones that are soft and non-damaging, such as kitchen sounds or a door closing.[5] Another example is watching someone blow up a balloon beyond its normal capacity. This is often an unsettling, even disturbing thing for a person with phonophobia to observe, as they anticipate a loud sound when the balloon pops.[1][5]

Phonophobia generally leads to anxiety around and avoidance of contexts where individuals might be exposed to feared sounds.[3] Such avoidance could risk making the auditory system more sensitive.[6]

Co-occurring conditions and differential diagnosis

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Although phonophobia can arise as a secondary consequence of other sound tolerance conditions, this does not make it synonymous with them.[3][6] As phonophobia refers specifically to irrational fears of sounds, not rational ones, phonophobic fear, anxiety, and avoidance would need to exceed the level expected due to the discomfort or pain caused by any other sound tolerance conditions.[7]

One other sound tolerance condition that can sometimes be observed alongside phonophobia is hyperacusis, or discomfort or even pain caused by sounds that most people would not consider uncomfortably loud.[3][5] Indeed, phonophobia is sometimes referred to as a specific type of hyperacusis, fear hyperacusis,[2] although other authors regard hyperacusis and phonophobia as distinct conditions,[3][6] insofar as hyperacusis involves discomfort caused by a physical sound whereas phonophobia does not.[3]

Another type of sound intolerance that can co-occur with phonophobia is misophonia, or emotional reactions to specific trigger sounds that need not be loud (e.g., anger in response to chewing sounds). Indeed, phonophobia has even been conceptualised as a type of misophonia.[8] However, other sources regard the specific phobia and anticipatory fears and avoidance of phonophobia as being distinct from the emotional reactions characteristic of misophonia.[3][4][6]

Moreover, phonophobia may co-occur with tinnitus (perception of sounds, especially ringing sounds, without an external source) or with generic noise sensitivity (sensory processing sensitivity towards sounds).[6]

Management

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To ensure that treatments and supports are directed appropriately, it is important to distinguish phonophobic fears from other sound tolerance conditions.[5][7] For example, exposure therapies are commonly used to treat specific phobias,[9] but could be considered to involve unacceptable risk if a patient were at significantly elevated likelihood of experiencing harm compared to other people who can engage in a given activity without incident.[10] As such, while there are specialised therapies for sound tolerance conditions like misophonia and hyperacusis that can involve exposure,[8] exposing people to sounds that cause them discomfort or pain could be harmful,[11] suggesting that exposure therapy – or at least more conventional forms of exposure therapy – may be more appropriate for pure phonophobia without other sound tolerance conditions.[7] Providing information and counselling regarding the benign nature of sounds eliciting phonophobic reactions is also recommended as a phonophobia treatment.[6]

Terminology and origins of the concept

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The term phonophobia comes from Greek φωνή - phōnē, "voice" or "sound"[12] and φόβος - phobos, "fear".[13]

When the word phonophobia was first introduced in 1949, it was as a synonym for hyperacusis, due to concern that the term hyperacusis might imply the presence of increased hearing acuity.[14] As a result, the word phonophobia has been used in neurology to refer to sound intolerance observed in people who experience migraine headaches, especially during migraines,[15] which is very distinct from the modern understanding of phonophobia.[3] The presence of such sound intolerance may be used to support the diagnosis of migraine.[15] Definitions and measures of the sound intolerance that can accompany migraines emphasise that it involves feelings of discomfort and auditory pain,[15][16] implying that the type of sound intolerance described would indeed be hyperacusis and not phonophobia.[6]

The contemporary concept of phonophobia was introduced by Margaret and Pawel Jastreboff in 2001.[17] They viewed phonophobia as a type of misophonia, emotional reactions to specific sounds.[17] Subsequently, phonophobia has generally been recognised as a distinct and separate condition from misophonia.[3][4][6]

See also

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References

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  1. ^ a b c Swerdlow B (1998). Whiplash and Related Headaches. p. 526.
  2. ^ a b Tyler RS, Pienkowski M, Roncancio ER, Jun HJ, Brozoski T, Dauman N, Coelho CB, Andersson G, Keiner AJ, Cacace AT, Martin N, Moore BC (2014). "A review of hyperacusis and future directions: Part I. Definitions and manifestations". American Journal of Audiology. 23 (4): 402–419. doi:10.1044/2014_AJA-14-0010. PMID 25104073.
  3. ^ a b c d e f g h i j Williams ZJ, He JL, Cascio CJ, Woynaroski TG (2021). "A review of decreased sound tolerance in autism: Definitions, phenomenology, and potential mechanisms". Neuroscience and Biobehavioral Reviews. 121: 1–17. doi:10.1016/j.neubiorev.2020.11.030. PMC 7855558. PMID 33285160.
  4. ^ a b c d Møller AR (2011). "Misophonia, Phonophobia, and "Exploding Head" Syndrome". In Møller AR, Langguth B, De Ridder D, Kleinjung T (eds.). Textbook of Tinnitus. Springer New York. pp. 25–27. doi:10.1007/978-1-60761-145-5_4. ISBN 978-1-60761-144-8.
  5. ^ a b c d Asha'Ari ZA, Mat Zain N, Razali A (January 2010). "Phonophobia and hyperacusis: practical points from a case report". The Malaysian Journal of Medical Sciences. 17 (1): 49–51. ISSN 2180-4303. PMC 3216140. PMID 22135526.
  6. ^ a b c d e f g h Henry JA, Theodoroff SM, Edmonds C, Martinez I, Myers PJ, Zaugg TL, Goodworth M (2022). "Sound Tolerance Conditions (Hyperacusis, Misophonia, Noise Sensitivity, and Phonophobia): Definitions and Clinical Management". American Journal of Audiology. 31 (3): 513–527. doi:10.1044/2022_AJA-22-00035. PMID 35858241.
  7. ^ a b c Scheerer NE, Boucher TQ, Arzanpour S, Iarocci G, Birmingham E (7 August 2024). "Autistic and Non-Autistic Experiences of Decreased Sound Tolerance and Their Association with Mental Health and Quality of Life". Autism in Adulthood aut.2023.0117. doi:10.1089/aut.2023.0117. ISSN 2573-959X.
  8. ^ a b Jastreboff PJ, Jastreboff MM (2015). "Handbook of Clinical Neurology". In Celesia GG, Hickok G (eds.). Decreased sound tolerance: Hyperacusis, misophonia, diplacousis, and polyacousis. Handbook of Clinical Neurology. Vol. 129. Elsevier. pp. 375–387. doi:10.1016/B978-0-444-62630-1.00021-4. ISBN 978-0-444-62630-1. PMID 25726280.
  9. ^ Böhnlein J, Altegoer L, Muck NK, Roesmann K, Redlich R, Dannlowski U, Leehr EJ (January 2020). "Factors influencing the success of exposure therapy for specific phobia: A systematic review". Neuroscience and Biobehavioral Reviews. 108: 796–820. doi:10.1016/j.neubiorev.2019.12.009. PMID 31830494.
  10. ^ Deacon B (2012). "The Ethics of Exposure Therapy for Anxiety Disorders". In Neudeck P, Wittchen HU (eds.). Exposure Therapy. Springer New York. pp. 9–22. doi:10.1007/978-1-4614-3342-2_2. ISBN 978-1-4614-3341-5.
  11. ^ Scheerer NE, Boucher TQ, Bahmei B, Iarocci G, Arzanpour S, Birmingham E (2022). "Family experiences of decreased sound tolerance in ASD". Journal of Autism and Developmental Disorders. 52 (9). Springer US: 4007–4021. doi:10.1007/s10803-021-05282-4. ISSN 1573-3432. PMID 34524587.
  12. ^ φωνή, Henry George Liddell, Robert Scott,A Greek-English Lexicon, on Perseus
  13. ^ φόβος, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus
  14. ^ Tschiassny, K. (August 1949). "Stapedioparalytic phonophobia ("hyperacusis") in a deaf ear: Case reports including studies on the analysis of the phenomenon and suggestions for possible applications of the phonophobia test". The Laryngoscope. 59 (8): 886–903. doi:10.1288/00005537-194908000-00005. ISSN 1531-4995. PMID 18135497.
  15. ^ a b c Vingen JV, Pareja J, Storen O, White L, Stovner L (June 1998). "Phonophobia in migraine". Cephalalgia. 18 (5): 243–249. doi:10.1046/j.1468-2982.1998.1805243.x. ISSN 1468-2982. PMID 9673802.
  16. ^ Ashkenazi A, Mushtaq A, Yang I, Oshinsky M (October 2009). "Ictal and Interictal Phonophobia in Migraine—A Quantitative Controlled Study". Cephalalgia. 29 (10): 1042–1048. doi:10.1111/j.1468-2982.2008.01834.x. ISSN 1468-2982. PMC 5011402. PMID 19735532.
  17. ^ a b Jastreboff, M. M., Jastreboff, P. J. (2001), Components of decreased sound tolerance: hyperacusis, misophonia, phonophobia
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