Phonophobia

Co-occurring conditions and differential diagnosis

Phonophobia can arise as a secondary consequence of other sound tolerance conditions, but it is not synonymous with them. The fear, anxiety, and avoidance must exceed what would be expected from discomfort or pain caused by other conditions. Hyperacusis, involving discomfort or pain from sounds not considered uncomfortably loud by most people, sometimes co-occurs; phonophobia is occasionally called fear hyperacusis, though some authors view them as distinct because hyperacusis involves physical discomfort while phonophobia does not.

Misophonia, emotional reactions to specific trigger sounds such as anger at chewing, can also co-occur, and phonophobia has been conceptualized as a type of misophonia, though other sources distinguish the anticipatory fears and avoidance of phonophobia from misophonia's emotional reactions. Phonophobia may also co-occur with tinnitus or generic noise sensitivity.

Management

Distinguishing phonophobic fears from other sound tolerance conditions is important for appropriate treatment. Exposure therapies, commonly used for specific phobias, may involve unacceptable risk if a patient has a significantly elevated likelihood of harm from sounds, as exposing people to sounds causing discomfort or pain could be harmful; thus conventional exposure therapy may be more suitable for pure phonophobia without other conditions. Providing information and counseling about the benign nature of sounds that trigger phonophobic reactions is also recommended.

Terminology and origins of the concept

The term phonophobia derives from Greek φωνή (phōnē, 'voice' or 'sound') and φόβος (phobos, 'fear'). When introduced in 1949, it was used as a synonym for hyperacusis due to concern that hyperacusis might imply increased hearing acuity. In neurology, phonophobia has referred to sound intolerance during migraine headaches, distinct from the modern understanding; such intolerance involves discomfort and auditory pain, indicating it is actually hyperacusis. The contemporary concept was introduced by Margaret and Pawel Jastreboff in 2001, initially viewing phonophobia as a type of misophonia, though it has since been generally recognized as a distinct condition.