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It's undoubtedly one of Junji Ito's most unsettling and disturbing stories with Ito implying a dark hidden meaning exploring suicide, but the anime actually manages to one-up its source material and make it even more horrific with sound.
Source: https://screenrant.com/junji-ito-maniac-hanging-balloon-scarier-sound/
The advert in Spanish-language newspapers, however, suggested the hidden meaning might have been intentional.