Clinical management of sound tolerance conditions (Henry et al., 2022)

Purpose: For some people, exposure to everyday sounds presents a significant problem. The purpose of this tutorial was to define and differentiate between the various sound tolerance conditions and to review some options for their clinical management.

Method: We informally reviewed the literature regarding sound tolerance conditions. The terminology and definitions provided are mostly consistent with how these terms are defined. However, many inconsistencies are noted. Methods of assessment and treatment also differ, and different methodologies are briefly described.

Results: Hyperacusis describes physical discomfort or pain when any sound reaches a certain level of loudness that would be tolerable for most people. Misophonia refers to intense emotional reactions to certain sounds (often body sounds such as chewing and sniffing) that are not influenced by the perceived loudness of those sounds. Noise sensitivity refers to increased reactivity to sounds that may include general discomfort (annoyance or feeling overwhelmed) due to a perceived noisy environment, regardless of its loudness. Phonophobia, as addressed in the audiology profession, describes anticipatory fear of sound. Phonophobia is an emotional response such as anxiety and avoidance of sound due to the “fear” that sound(s) may occur that will cause a comorbid condition to get worse (e.g., tinnitus) or the sound itself will result in discomfort or pain. (Note that phonophobia is a term used by neurologists to describe “migraineur phonophobia”—a different condition not addressed herein.)

Conclusions: The literature addresses sound tolerance conditions but reveals many inconsistencies, indicating lack of consensus in the field. When doing an assessment for decreased sound tolerance, it is important to define any terms used so that the patient and all health care professionals involved in the care of the patient are aligned with the goals of the treatment plan. Treatment generally involves gradual and systematic sound desensitization and counseling.

Supplemental Material S1. Tinnitus and Hearing Survey. 

Supplemental Material S2. Sound Tolerance Interview. 

Henry, J. A., Theodoroff, S. M., Edmonds, C., Martinez, I., Myers, P. J., Zaugg, T. L., & Goodworth, M.-C. (2022). Sound tolerance conditions (hyperacusis, misophonia, noise sensitivity, and phonophobia): Definitions and clinical management. American Journal of Audiology. Advance online publication. https://doi.org/10.1044/2022_AJA-22-00035