Noise sensitivity

Misophonia, hyperacusis and phonophobia

However, not all people find noise equally disturbing. Some people react much more sensitively than others. This group does not necessarily hear better than others. During the examination by the ENT physician, the hearing test reveals normal hearing ability.

However, those affected have a different perception of loudness, which manifests itself in a lowering of the discomfort and pain threshold. They feel disturbed by sounds much earlier. The phenomenon is medically referred to as hyperacusis (hyper = too much). If sounds are perceived as painful at an early stage, this is called hyperacusis dolorosa (dolorosa = painful).

Another form of hypersensitivity is the so-called misophonia. In this case, people feel a considerable aversion, even disgust or anger, towards certain sounds. Often these are chewing or smacking sounds.

Where does this come from? What is to be done?

About noise sensitivity

We can close our eyes, but not our ears. Biologically, this makes a lot of sense, since hearing is our most important sensory organ in the event of danger. Even when we are asleep, it is continuously active and wakes us up when threatening sounds have been registered.

The complaint about noise is an old one. Almost 2000 years ago, the Roman poet Juvenal already complained about the impossibility of sleeping in the city at night. But in recent decades, noise pollution has actually increased significantly. Road and aircraft noise play the decisive role. 60% of the population suffers from road noise, about half from aircraft noise.

The increasing noise pollution has been studied many times and has been sufficiently proven. It has two main consequences:

Damage to the hearing organ. These are, above all, hearing loss and tinnitus. About 20% of the population in Germany suffer from both types of complaints.
Psychological consequences of noise exposure: Noise triggers an inner stress reaction. It is as if we are physically threatened. Noise at night in particular impairs sleep, since it subliminally signals a danger to which the body adjusts by producing more stress hormones.

Forms of noise sensitivity

Misophonie

What is misophonia

In 2002, Pavel and Margaret Jastreboff published an article in which they described the peculiar phenomenon in detail for the first time. They proposed the term "misophonia" ("hatred of sound" ), which has become relatively well established in recent years.

What is meant is an abnormal sensitivity to sound, which does not refer to all but only to very specific sound signals and which cause a relatively uniform pattern of complaints.

Those affected react with a strong aversion or disgust, which quickly turns into anger or even sheer rage and often results in a long-term withdrawal. At the same time, physical symptoms such as palpitations, muscle tension, changes in breathing, inner restlessness and other signs of sympathetic nervous system activation appear.

Hypersensitivity to...

Smacking, chewing and swallowing noises, slurping, chewing gum
Loud breathing, sighing, snoring, throat clearing, coughing, sniffling
Sharp consonants such as "S" or "K", cracking of joints
Typing on tabletops or keyboard, clicking with ballpoint pens, dripping water
Baby, child crying
Environmental noises, engine noise

So the complaints are not limited to noises made while eating or drinking. Ultimately, any noise can take on a negative meaning and become a trigger.

No diagnosis

"Misophonia" is by no means an established diagnosis or new disease. It is an attempt to describe a sensation and thus perhaps to understand it better. Currently, there are also no uniform criteria.

However, the following are often used.

A human-generated sound or its anticipation triggers rejection, disgust, and quickly turns into anger.
The anger threatens self-control and can end in aggressive outbursts.
Criticism and self-insight are maintained. The person recognizes the disproportionality of his or her own response.
There is significant subjective impairment or suffering.
Disgust or anger cannot be explained by other disorders or biographical experiences.

Frequency

It is of course difficult to determine the frequency of a symptomatology that is not clearly defined. Therefore, depending on the study, different numbers can be found. Almost one in five college students are said to be affected, 60% of patients with tinnitus and as many as 90% of noise-sensitive people. Estimates assume that 4-5% of the total population suffers from more or less pronounced misophonia.

Misokinesie

"Just the sight of it makes my skin crawl".

After prolonged symptomatology, not only the sounds themselves but already the sight of the corresponding triggers can trigger the same disgust and anger without the actual sounds themselves being perceived. Thus, some affected persons react excessively to knee bobbing, chewing, teeth brushing, finger tapping, fiddling with the hair, nail biting, lip licking, thumb twiddling, and so on. This variant is sometimes referred to as "misokinesia," or hatred of movement.

Phonophobie

Delimitation

Sometimes misophonia is also distinguished from "phonophobia" (fear of sounds). The difference is rather small. In phonophobia, fear is said to predominate, while in misophonia, disgust, revulsion, and anger dominate.

Another distinction concerns general sensitivity to stimuli. There are people who are more sensitive to all external stimuli. According to our own online research with more than 1000 participants, sensitivity to sound was shown to be highly associated with sensitivity to light and sensitivity to smell.

Characteristics

A certain form of aversion to loud smacking and grunting is probably more the rule than the exception. Most people are also not enthusiastic about the sound of constantly drumming fingers on the tabletop. A certain degree of misophonia should therefore be quite normal.

The degree of misophonia can be measured with scales. In an 11-step questionnaire, the expression is described like this:

I am aware of the presence of a known trigger person, but feel no or minimal anticipatory anxiety.
Known trigger sounds cause minimal psychological discomfort, irritation, or annoyance. No symptoms of panic or fight or flight response.
I feel increasing levels of psychological discomfort but show no physical reaction. I may be hyper-vigilant to audio-visual stimuli.
I am experiencing significant psychological discomfort and some violent thoughts.
Panic/rage reaction in full swing. Conscious decision not to use force on the person triggering the noise. Actual flight from the vicinity of the noise and/or use of physical force on an inanimate object. Panic, anger, or severe irritability may be evident in my behavior.
Actual use of physical force on a person or animal (e.g., a pet). Violence may also be used against oneself (self-harm).

Causes

The most common is probably a misprocessing of sound impressions. The stimuli are not sufficiently filtered. In short, the stimulus threshold for the signals is lowered. This type of malprocessing is most likely to be present in fibromyalgia, migraine, depression and anxiety disorders.
The increased sensitivity to noise in hearing impaired people has a paradoxical effect. In hearing-impaired individuals, soft sounds are automatically amplified, while sounds that are too loud are muffled. The phenomenon is called "recruitement", i.e. a kind of "loudness compensation". In the hearing impaired, this recruitement fails. They then both fail to understand soft speech ("Speak up, please") and, due to the failure of recruitement, find loud speech unpleasant ("Don't shout like that").
Other diseases can also lead to hyperacusis: Tumors, certain medications, migraine, neurological diseases, epilepsy, tinnitus, and in the usually unilateral failure of the stapedius reflex, a protective mechanism in which the stapes in the middle ear is tilted away to protect against loud sounds.

Causes in misophonia: Disgust!

The hypersensitivity to sounds could actually be demonstrated in so-called functional MRI examinations. The affected persons showed an increased blood flow in the frontal brain and tonsillar nucleus after unpleasant noises. But this result is by no means an indication of organic damage. It is merely the physical correlate of the sensation.

The core of misophonia is not fear but disgust. As a result, those affected turn away, they want to flee. If this is not possible, aggression or anger develops.

Disgust is an innate feeling that is supposed to protect us from intoxication. It can be paired with a gag reflex or nausea. The sight of depravity "grosses us out." While innate "core disgust" refers to poison, excrement, and bodily fluids, there are also derivative, indirect forms that depend heavily on upbringing.

Misophonia usually becomes understandable only at this level of personal experience. In certain situations, three things usually come together: An unpleasant emotional experience, a certain acoustic signal and a lack of retreat. Thus, a classic conditioning like Pavlov's dog can develop.

If then in the consequence the attention is directed to the appropriate noises, the problem is strengthened naturally. If now also such situations are avoided, the symptomatology becomes better in the short term but worse in the long term. Who goes because of a dog phobia all four-legged friends from the way, has hardly chances to overcome the fear, because he can make no corrective experiences. Most dogs do not bite.

Therapy

Staged exposure

Avoiding loud noises may be understandable. However, it is only useful to a very limited extent. Although those affected find a certain relief in the quiet, the increased sensitivity does not subside in this way. Wearing noise protection (e.g. earplugs) is at most an emergency solution. By avoiding the noise, the hearing gets used to the quiet ambient noise and a vicious circle of increased sensitivity and avoidance of noise ensues.

As with the other conditions presented here, raising the threshold of sensitivity is the more effective approach in the long term. In addition to the general recommendations, however, there are more specific therapeutic procedures.

Basically, it is about how an increased tolerance for sounds can be achieved step by step. Training is used to overcome avoidance behavior and fear.