Noise Aversion: Stop the Suffering with Early Diagnosis and Treatment
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Canine noise aversion—also known as noise anxiety or phobia—affects 67% of dogs in the United States,1 yet only a small percentage of these dogs are diagnosed and treated. Why are so many dogs not receiving treatment?
The problem is often rooted in how dog owners perceive noise aversion. Many pet owners do not view noise aversion as a medical issue, so they do not discuss their concerns with their veterinarians. Often, pet owners assume that their dog’s noise aversion is normal or think they can control their pet’s anxiety by holding and comforting them. Unfortunately, both of these assumptions are incorrect. When pet owners are not proactive in discussing their pet’s noise aversion, veterinarians miss the opportunity to help address both the problem and their patient.
The causes of noise aversion are not fully understood; however, early exposure to noise may predispose to aversion for some noises and protect from aversion for other noises because of lack of habituation, dishabituation, or sensitization.2 Genetics has been suggested as a basis for noise aversion for pointers and herding breeds, and the involvement of multiple genes could explain the various presentations.3,4 Finally, fear is enhanced by repeated exposure to the sound stimulus.5
Noise aversion can have a negative effect on the owner’s quality of life. Dogs that react to noises occurring in the middle of the night can interrupt their owner’s sleep. Owners worry about the wellbeing of dogs that cause property damage and/or self-trauma, and the cost of home repair and veterinary bills may become excessive. This can have a negative effect on the human–animal bond, possibly leading the owner to consider surrender or euthanasia.
The need to proactively diagnose and treat is overwhelming. First, it is important to understand that dogs experiencing noise aversion are akin to a person having a panic attack. These dogs are suffering, and, therefore, noise aversion is a true welfare concern that should be considered an important medical condition. If left untreated, noise aversion can progress to fear of multiple types of noises, the signs can become more severe, or dogs may require more time to recover after each noise event. Dogs with noise aversion may also develop other comorbidities, such as separation or general anxiety.
The noise aversion checklist (Figure 1) provides a simple and efficient way to start the discussion about noise aversion. The checklist identifies triggers and signs and helps determine severity. Although thunder and fireworks are the most commonly reported triggers for noise aversion, other everyday noises should also be considered. These can include construction noises (in the house or your neighborhood), garbage trucks, snowplows, doorbells, specific music/tones (phone rings, alarms, sirens), and other street noises. See Table 1 for a complete list of noise triggers.
Many signs can indicate noise aversion (Box 1). Severity can be assessed by asking about the intensity of the reaction, the frequency of noise aversion events, and how soon the dog recovers from the event once the noise has stopped.
After the diagnosis is made, a multimodal treatment plan can include environmental management, behavior modification, and pharmacologic options. Pharmacologic agents should be initiated early because noise aversion is a neurologic disease and requires medication that can treat the cause.4 Consultation with a veterinary behaviorist can help in developing a treatment plan.
Ideally, the client would prevent exposure to the noise trigger. Because that is not practical in most situations, environmental management can include minimizing the noise by closing the blinds and moving the pet to a soundproof inner room, playing soft music, distracting the dog with a favorite toy or indoor activity, and creating a safe haven. Use of pheromones and wearables may also help the dog feel calmer, but environmental management alone is typically not enough to treat noise aversion.
Systematic desensitization using commercially available CDs or apps that reproduce the sound of thunder are effective for some dogs with thunderstorm phobia. Counterconditioning techniques can be tailored to the individual patient, and for some patients a combination of these 2 techniques may be required to help manage noise aversion.
Although many pharmacologic agents are available, only a few have been show to be effective in published clinical studies, including clonidine,6 clomipramine,7,8 trazadone,9 imepitoin,10 and dexmedetomidine oromucosal gel.11 Of these, only the latter two are Food and Drug Administration approved for the treatment of canine noise aversion. Although imepitoin is not expected to be commercially available in the United States until the end of 2020, it comes in 100- and 400-mg tablets. The dosage for noise aversion is 30 mg/kg q 12 h starting 2 days before and continuing through the noise event. In a randomized, placebo-controlled clinical study, 66.2% of the imepitoin-treated dogs had an excellent or good response vs 25% of placebo-treated dogs; the difference was significant at p=0.0001. The most common adverse events included ataxia (34% of treated dogs), increased appetite (18%), and lethargy (11%), rates higher than those in the placebo-treated dogs.12
Dexmedetomidine oromucosal gel is an oral agent administered transmucosally and supplied in a 3-mL preloaded syringe. The dose is 125 mcg/m2; however, with a bioavailability of 28%, only about one fourth of the administered dexmedetomidine is absorbed. At this dose, the agent calms without sedation. It has a flexible dosing schedule and can be administered 30 to 60 minutes before the noise occurs, at the time the noise is first heard, or when the dog begins to show signs. The duration of effect is 2 to 3 hours, so additional doses may be administered if the noise continues or recurs after 2 hours and the dog begins to show signs of noise aversion. Up to 5 doses may be administered for each noise event. In a randomized placebo-controlled clinical study, 75% of the dexmedetomidine-treated dogs had an excellent or good response vs 33% of the placebo-treated dogs (p<0.0001). The most common adverse events included transient pale mucous membranes at the sight of application and emesis (4.4% of the dexmedetomidine-treated dogs). No dogs in the dexmedetomidine group showed excessive signs of sedation.13
Canine noise aversion is a serious medical condition that requires early diagnosis and treatment to prevent the dog from suffering and improve the dog’s quality of life. The noise aversion checklist (Figure 1) provides a simple and effective way to make the diagnosis. Treatment can be multimodal but should include a pharmacologic option to treat the underlying cause and to provide the best results.
IMPORTANT SAFETY INFORMATION: Do not use SILEO in dogs with severe cardiovascular disease, respiratory, liver or kidney diseases, or in conditions of shock, severe debilitation, or stress due to extreme heat, cold or fatigue or in dogs hypersensitive to dexmedetomidine or to any of the excipients. SILEO should not be administered in the presence of preexisting hypotension, hypoxia, or bradycardia. Do not use in dogs sedated from previous dosing. SILEO has not been evaluated in dogs younger than 16 weeks of age or in dogs with dental or gingival disease that could have an effect on the absorption of SILEO. SILEO has not been evaluated for use in breeding, pregnant, or lactating dogs or for aversion behaviors to thunderstorms. Transient pale mucous membranes at the site of application may occur with SILEO use. Other uncommon adverse reactions included emesis, drowsiness or sedation. Handlers should avoid direct exposure of SILEO to their skin, eyes or mouth. Failure to lock the ring-stop on the syringe before dosing SILEO could potentially lead to an accidental overdose. Always review INSTRUCTIONS FOR USE before dispensing and dosing.
1. Harris Poll: Custom Motion Sickness and Noise Aversion Omnibus Pet Owner Quantitative Research Report. December 2018.
2. Sherman BL, Mills DS. Canine anxiety and phobias: an update on separation anxiety and Noise Aversions. Vet Clin North Am Small Anim Pract 2008;38:1081-1106.
3. Murphree O, Dykman R, Peters J. Genetically-determined abnormal behavior in dogs: results of behavioural tests. Conditional Reflex 1967;2:199-205.
4. Overall KL. Manual of Clinical Behavioral Medicine for Dogs and Cats. St Louis, MO: Elsevier Mosby; 2013:256-261.
5. Shull-Selcer EA, Starr W. Advances in the understanding and treatment of noise phobias. Vet Clin North Am Small Anim Pract 1991;21:353-367.
6. Ogata N, Dodman DH. The use of clonidine in the treatment of fear-based behavior problems in dogs: an open trial. J Vet Behav 2011;6:130-137.
7. Seksel K, Lindeman MJ. Use of clomipramine in treatment of obsessive-compulsive disorder, separation anxiety and noise phobia in dogs: a preliminary, clinical study. Aust Vet J 2001;79:252-256.
8. Crowell-Davis SL, Seibert LM, Sung W, et al. Use of clomipramine, alprazolam and behavior modification for treatment of storm phobia in dogs. JAVMA 2003;222:744-748.
9. Gruen ME, Sherman BL. Use of trazodone as an adjunctive agent in the treatment of canine anxiety disorders: 56 cases (1995–2007). JAVMA 2008;233:1902-1907.
10. Odilo Engel O, Müller H, Klee R, et al. Effectiveness of imepitoin for the control of anxiety and fear associated with noise phobia in dogs. J Vet Intern Med 2019;33(6):2675-2684.
11. Korpivaara M, Laapas K, Huhtinen M, et al. Dexmedetomidine oromucosal gel for noise associated acute anxiety and fear in dogs—a randomised, double-blind, placebo-controlled clinical study. Vet Rec 2017;180(14):356.
12. Freedom of information summary: Original New Animal Drug Application. NADA 141-509, PexionTM (imepitoin tablets), dogs. December 4, 2018. animaldrugsatfda.fda.gov/adafda/app/search/public/document/downloadFoi/5907 Accessed March 2020.
13. Freedom of information summary: Original New Animal Drug Application. NADA 141-456, SILEO (dexmedetomidine oromucosal gel), dogs. November 19, 2015. animaldrugsatfda.fda.gov/adafda/app/search/public/document/downloadFoi/942 Accessed March 2020.