How to overcome phonophobia when you have tinnitus or hyperacusis

Imagine stepping outside on a beautiful day, only to feel your heart race with anxiety at the sound of birds chirping or your neighbor driving by in their SUV. For people living with phonophobia (intense fear of sound), the world can feel like a terrifying place filled with endless auditory threats.

In my work as a tinnitus and hyperacusis coach, I have found that many patients develop phonophobia as a side effect of the unpredictable nature of these conditions, especially when both are present. And it can really exacerbate suffering.

Relief is always possible, but if you don’t also address the fear of sound, it can make it much more challenging to desensitize to hyperacusis and habituate to tinnitus.

I have seen firsthand how severely phonophobia can affect and shrink people’s lives. But I have also found that many of my clients are able to overcome their fear of sound much faster than they are able to habituate and desensitize, leading to big jumps in quality life early in the process.

In this column, I’m going to help you to gain a deeper understanding of phonophobia, how it affects and interacts with tinnitus and sound sensitivity, and most importantly, how it can be overcome.

What is phonophobia?

Phonophobia is defined as having an intense fear of, or aversion to, specific sounds. Usually, it’s loud, sudden, or high-pitched noises. But sometimes common environmental sounds are problematic as well. In many cases, everyday noises like the clinking of silverware on a dish or the hum of a refrigerator can trigger intense anxiety and panic in a person struggling with phonophobia.

This reaction is more than just physical discomfort or annoyance, it’s a conditioned fear response that can deeply affect a person emotionally, psychologically, and physiologically.

For patients with bothersome reactive tinnitus and hyperacusis (especially reactive tinnitus), this vicious cycle of nervous system response sounds all too familiar. The line between these conditions gets blurry, especially considering I view the problem of bothersome tinnitus and hyperacusis as a kind of acute stress disorder, similar to PTSD.  But technically speaking, what differentiates phonophobia from tinnitus, hyperacusis, and other sound tolerance conditions is that it is a psychological condition rooted in fear and not a sensory problem.

Fear of sound and sound avoidance

Phonophobia often develops in response to painful, scary, or traumatic experiences with sound, such as noise-induced hearing loss, sound-triggered tinnitus spikes, or sound sensitivity (especially when painful).

Over time, a person’s ongoing fear causes the brain and nervous system to associate certain sounds with danger, often leading to intense anxiety even in the absence of a triggering noise, when the person only anticipates a potential sound exposure.

This all leads to sound avoidance, social avoidance, life avoidance, and higher levels of anxiety and depression across the board.

But it’s actually good news that phonophobia is a fear-based condition. Because fears can be faced, conquered, and unlearned. Phobias of all varieties can be fully resolved.

The phonophobia-hyperacusis feedback loop

In my experience working with patients, most (if not all) hyperacusis sufferers also experience some degree of phonophobia as well. And the two conditions can quickly become entangled in a self-reinforcing negative feedback loop.

More often than not, hyperacusis comes first and causes phonophobia as a secondary response. When every day sounds are uncomfortably loud or painful, it’s only natural that a person would become fearful of sound as well. Fear is an evolutionary survival and protection mechanism.

The problem is that the world is a noisy place, and patients get stuck in this state of fear, causing it to intensify. As a result, the brain and nervous system become increasingly more hypervigilant to sound, constantly scanning the environment for potential threats. And this heightened state of alertness only causes the auditory system to become more reactive, amplifying the distress of hyperacusis and further diminishing sound tolerance.

But phonophobia can also give rise to hyperacusis. When a non-sound-sensitive person has a scary or traumatic experience involving a loud noise, and develops phonophobia as a result, they change their behavior.

They often begin to avoid everyday sounds, and wear hearing protection when unnecessary. This avoidance may help them reduce anxiety in the short term, but it also directly reduces their sound tolerance as well. Sounds that were once completely comfortable start to feel overwhelming from lack of exposure, and patients are often unaware this is happening until it’s too late.

But regardless of which comes first, when experienced together, each condition intensifies the other. It becomes a vicious cycle where the fear of sound worsens sensitivity, and the sensitivity reinforces the fear. Breaking this cycle requires a multi-pronged approach that addresses both the emotional response and the nervous system's heightened reactivity at the same time.

The fear of sound making tinnitus worse

When you live with bothersome tinnitus, it rarely ever remains constant. Many patients experience fluctuations in volume, sound, and tone, and these fluctuations are often triggered by various lifestyle and environmental factors. Every case is a bit different, but loud sound exposure is a trigger for nearly all tinnitus sufferers.

Tinnitus spikes are challenging enough on their own. But when loud sounds, or specific noises repeatedly trigger difficult spikes, phonophobia is often the result. This is especially true in cases where the initial onset of tinnitus followed an acoustic trauma, such as a loud concert, a sudden explosion, or an accident involving high-decibel noise, like a gun shot.

When phonophobia occurs in tinnitus patients, the fear that certain sounds will make their tinnitus worse becomes another negative conditioned response that only intensifies tinnitus reactivity.

I’ve worked with many patients who experience tinnitus spikes entirely from the anxiety they feel when exposed to a triggering sound, even if the sound is very quiet. Often, simply anticipating a difficult sound can cause enough anxiety to trigger a tinnitus spike in absence of any noise at all.

The phonophobia becomes another pathway to pull a tinnitus patient deeper into the vicious cycle of fight or flight nervous system activation, aggravating their tinnitus further in the process. In some cases, the resulting phonophobia can cause a tinnitus patient to develop hyperacusis as well.

But again, this fear response can be reversed, and it often happens early in the habituation process. Once tinnitus patients become empowered with a better understanding of the problem, as well as effective coping tools and strategies, they start to find that the specific sounds they’ve been avoiding don’t always trigger spikes. And with this new evidence, the fear begins to fade.

Three powerful strategies to resolve phonophobia

Phonophobia is deeply rooted in fear, and facing your fears is never easy. But this is a completely solvable problem. Fears can be unlearned, and with time and a little bit of work, phonophobia can be resolved entirely. 

There are many strategies that can help here.

1. Relaxation-enhanced gradual exposure therapy

I developed this protocol several years back and it quickly became my most effective strategy to help patients with phonophobia (and hyperacusis) extinguish their fear response to sound.

Gradual exposure therapy has long been the gold standard to resolve phobias of all kinds. This approach is commonly used with phonophobia and hyperacusis to help patients desensitize. The problem is that we rarely have control over the random noises we encounter out in the world. Sudden unexpected noises can lead to big setbacks in progress.

But I have found that you can get significantly better results by combining gradual sound exposure therapy with deeply relaxing meditation techniques and breathing exercises.

Most people can tolerate even highly triggering sounds when played at very low volume levels. By having patients meditate or practice breathing techniques while listening to triggering sounds, the nervous system begins to associate the resulting relaxation state with the triggering noise. It acts as a kind of positive state conditioning that extinguishes the fear.

Any form of meditation or breathing technique that reliably induces relaxation can be effective. The trick is setting the volume of the sound therapy to a level that triggers no more than 10% discomfort and keeping it consistent each day. It’s just enough discomfort to engage the fear response slightly, but not so much that a person will not be able to achieve a state of relaxation while they meditate or utilize breathing exercises.

Typically, after 3-5 days of repetition, a person will find that the volume level is now completely comfortable, at which point the volume is increased, and the process is repeated.

Pro tip: Headphones can work well for this, but a Bluetooth speaker offers more precise volume control, because you move the speaker closer or further away from you.

2. Using earplugs strategically

Earplugs are important tools for patients struggling with phonophobia, but it’s a double-edged sword. On the one hand, earplugs will protect you and your ears from dangerous, harmful levels of sound. They can also give you the confidence you need to face environments where triggering noises may appear. But the overuse of hearing protection, especially in safe environments, is an avoidance pattern that increases fear and can lead to sound sensitivity.

The problem is that both phonophobia and hyperacusis make it very difficult for patients to accurately judge whether a sound is in fact too loud or not. Remember, a noise can trigger major anxiety at completely safe volume levels.

I always recommend clients carry earplugs with them when they go out, but to only use them when actually necessary. And to use high-fidelity musicians’ earplugs, which reduce the decibel level of sound evenly across all frequencies but still let sound through, whenever possible.

3. Expand your comfort zone gradually

Many people with phonophobia, tinnitus, and hyperacusis believe their symptoms need to improve for them to start living life again. But that isn’t true. The fastest results are always achieved by both working on the problem and re-engaging with life as much as possible.

People with these conditions tend to make their world very small when they are suffering as a consequence of actual real-world limitations, but also because of fear. When the world is small, we feel safer because we are able to control more of the variables. But as a person starts to improve and their limitations expand, their fear often prevents them from taking steps forward back into the world.

At every point of the process, there is a gap between a person’s perceived limitations–their comfort zone–and their actual limitations.

Imagine two concentric circles: The inner circle represents your current comfort zone, including all the sounds, activities, and environments where you feel safe. The outer circle represents your actual limitations–everything you can tolerate safely given your current level of progress.

The gap between these two circles is comprised entirely of fear.

But you do not have to wait until you feel ready to begin living life. You can start by reintroducing activities you used to enjoy, modifying and protecting yourself as needed. You can go to your favorite store during a quieter time. You can sit in a cafe with noise-canceling headphones. When you focus on prioritizing small wins, your confidence will grow.

Each successful step forward out of the inner circle – every moment when a sound did not affect you like you expected it to – becomes another piece of evidence that you’re safe.

And as the fear fades, quality of life often improves dramatically, even if your symptoms are still present. Confidence grows and the two circles will start to merge.

Final thoughts

When sounds trigger anxiety everywhere you go, it can turn your life into a living nightmare. And as your world shrinks down in size, the future can start to seem more and more uncertain.

But phonophobia is a learned response, and as such, it can be unlearned entirely.

With the right strategies, support, and mindset, it is entirely possible to erase your fear of sound. Whether you are dealing with tinnitus, hyperacusis, or any other form of sound sensitivity, resolving phonophobia can accelerate your healing and dramatically improve your quality of life.

You don’t have to eliminate your symptoms to start feeling better. You just have to start moving forward. Relief is possible. Recovery is real. And it all starts with a single, courageous step outside your comfort zone.

More: 

• Symptoms and treatments for hyperacusis, misophonia and phonophobia
• Hyperacusis, tinnitus, and sound tolerance: Finding relief from noise