About Decreased Sound Tolerance…

Decreased Sound Tolerance (DST) is a condition where every-day sounds that do not normally bother most people become abnormally bothersome in some way.  There are three general categories of DST: Hyperacusis, Misophonia, and Phonophobia. DST is thought to be caused by an oversensitivity within the brain’s auditory circuitry that causes sounds which would normally be comfortable to cause pain, annoyance or discomfort.


  • Hyperacusis is the most common of the three categories of Decreased Sound Tolerance.
  • It is condition where the oversensitivity in the auditory system makes ordinary sounds of daily life uncomfortably loud, almost as though the brain’s internal volume control were turned up.  
  • The sounds most commonly reported as uncomfortable are high pitch sounds and sounds that begin abruptly
  • Some indicators that a person may be experiencing hyperacusis include abnormal use of ear plugs or muffs for sounds that would not normally be considered too loud, or avoidance of situations where noise is present such as restaurants, social or sports events, or other sound-rich environments
  • Hyperacusis may be associated with tinnitus, noise-induced hearing loss, head injury, Lyme’s disease, Bell’s palsy, migraine, post-traumatic stress disorder, and multiple sclerosis, among others
  • Symptoms can vary with stress and fatigue levels


  • Misophonia is diagnosed when there is an extreme emotional or annoyance reaction to soft sounds, most commonly sounds related to eating such as chewing, lip smacking, swallowing, etc.  
  • Reactions can vary from unreasonable annoyance to angry outbursts as a result of the sound triggering a hyperactive response within the emotional centres of the brain


  • Phonophobia is diagnosed when aversion to sound amounts to a fear that causes the person to avoid sound or events associated with sound, or to attempt to manage their environment to eliminate certain sounds.
  • Untreated, phonophobia can result in a person withdrawing from social interaction and interfere with employment and relationships

What to Do…

When any aspect of Decreased Sound Tolerance is present, it is important undergo a full hearing assessment and evaluation of the sound tolerance issues.  Be sure to let us know before your assessment that you have decreased sound tolerance so we can modify our tests to keep you comfortable. Once any medical causes requiring referral have been ruled out, our audiologist will discuss options with you and develop a treatment plan that meets your needs.  With treatment, your symptoms should improve over a period of several months to two years.

What to Expect in a Decreased Sound Tolerance Assessment…

An assessment of Decreased Sound Tolerance includes a full hearing assessment and also gives our hearing professionals much more information about the type of sounds you find bothersome, your reactions to sound, and your most common triggers.  This exam takes about an hour and includes:

  • A review of your general and hearing health history, and your specific concerns
  • A visual inspection of your ear canals and ear drums
  • A full hearing assessment
  • Tests to determine the point at which sounds of various kinds become too loud for you

To determine the most suitable solutions to treat your Decreased Sound Tolerance, a full assessment is essential.  The goals of the assessment are to give us information regarding:

  • The type and degree of any hearing loss that may be present
  • Whether medical intervention is warranted
  • The most suitable treatment options to achieve relief from your specific sound tolerance issues

Following the assessment, your results will be reviewed with you, along with our recommendations for treatment.  You are welcome to ask questions at any time during this process and to bring a friend or family member to your appointment.

Solutions available to address Decreased Sound Tolerance…

Following your assessment, solutions to address your DST will be discussed with you.  These may include one or more of the following:

  • Educational information to help you understand your DST
  • The latest technology in sound therapy devices in a variety of styles from leading manufacturers, and all associated support and services
  • DST Educational Counselling

The level of support needed to experience relief from symptoms varies from person to person, and each treatment program is tailored to the individual needs through consultation between our audiologist and each DST patient.

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