Search

Hyperacusis is highly prevalent in the autism spectrum disorder (ASD) population. This auditory hypersensitivity can trigger pragmatically atypical reactions that may impact social and academic domains. Objective: The aim of this report is to describe the relationship between decreased sound tolerance disorders and the ASD population. Topics covered: The main topics discussed include (1) assessment and prevalence of hyperacusis in ASD; (2) etiology of hyperacusis in ASD; (3) treatment of hyperacusis in ASD. Conclusions: Knowledge of the assessment and treatment of decreased sound tolerance disorders within the ASD population is growing and changing.

Misophonia is characterised by a low tolerance for day-to-day sounds, causing intense negative affect. This study conducts an in-depth investigation of 35 misophonia triggers. A sample of 613 individuals who identify as experiencing misophonia and 202 individuals from the general population completed self-report measures. Using contemporary psychometric methods, we studied the triggers in terms of internal consistency, stability in time, precision, severity, discrimination ability, and information. Three dimensions of sensitivity were identified, namely, to eating sounds, to nose/throat sounds, and to general environmental sounds. The most informative and discriminative triggers belonged to the eating sounds. Participants identifying with having misophonia had also significantly increased odds to endorse eating sounds as auditory triggers than others. This study highlights the central role of eating sounds in this phenomenon and finds that different triggers are endorsed by those with more severe sound sensitivities than those with low sensitivity.

Misophonia is a common disorder characterized by the experience of strong negative emotions of anger and anxiety in response to certain everyday sounds, such as those generated by other people eating, drinking, and breathing. The commonplace nature of these “trigger” sounds makes misophonia a devastating disorder for sufferers and their families. How such innocuous sounds trigger this response is unknown. Since most trigger sounds are generated by orofacial movements (e.g., chewing) in others, we hypothesized that the mirror neuron system related to orofacial movements could underlie misophonia. We analyzed resting state fMRI (rs-fMRI) connectivity (N = 33, 16 females) and sound-evoked fMRI responses (N = 42, 29 females) in misophonia sufferers and controls. We demonstrate that, compared with controls, the misophonia group show no difference in auditory cortex responses to trigger sounds, but do show: (1) stronger rs-fMRI connectivity between both auditory and visual cortex and the ventral premotor cortex responsible for orofacial movements; (2) stronger functional connectivity between the auditory cortex and orofacial motor area during sound perception in general; and (3) stronger activation of the orofacial motor area, specifically, in response to trigger sounds. Our results support a model of misophonia based on “hyper-mirroring” of the orofacial actions of others with sounds being the “medium” via which action of others is excessively mirrored. Misophonia is therefore not an abreaction to sounds, per se, but a manifestation of activity in parts of the motor system involved in producing those sounds. This new framework to understand misophonia can explain behavioral and emotional responses and has important consequences for devising effective therapies. SIGNIFICANCE STATEMENT Conventionally, misophonia, literally “hatred of sounds” has been considered as a disorder of sound emotion processing, in which “simple” eating and chewing sounds produced by others cause negative emotional responses. Our data provide an alternative but complementary perspective on misophonia that emphasizes the action of the trigger-person rather than the sounds which are a byproduct of that action. Sounds, in this new perspective, are only a “medium” via which action of the triggering-person is mirrored onto the listener. This change in perspective has important consequences for devising therapies and treatment methods for misophonia. It suggests that, instead of focusing on sounds, which many existing therapies do, effective therapies should target the brain representation of movement.

We investigated auditory processing in a young patient who experienced a single embolus causing an infarct in the right middle cerebral artery territory. This lead to damage to auditory cortex including planum temporale that spared medial Heschl’s gyrus, and included damage to the posterior insula and inferior parietal lobule. She first reported difficulty hearing all sounds, which fully recovered within days, but she subsequently reported chronic difficulties with segregating speech from noise and segregating elements of music. Clinical tests showed no evidence for abnormal cochlear function. Follow-up tests confirmed difficulties with auditory segregation in her left ear that spanned multiple domains, including speech-in-noise and music streaming. Testing with a stochastic figure-ground task—a way of estimating generic acoustic foreground and background segregation—demonstrated that this was also abnormal. This is the first demonstration of an acquired deficit in the segregation of complex acoustic patterns due to cortical damage, which we argue is a causal explanation for the symptomatic deficits in the segregation of speech and music. These symptoms are analogous to the visual symptom of simultaneous agnosia. Consistent with functional imaging studies on normal listeners, the work implicates non-primary auditory cortex. Further, the work demonstrates a (partial) lateralisation of the necessary anatomical substrate for segregation that has not been previously highlighted.HighlightsRare case of auditory agnosia in a young patient with a right-hemisphere infarctDamage affecting non-primary auditory cortex, but sparing primary auditory cortexGeneralised auditory segregation deficit, revealed by auditory figure-ground taskThis explains segregation deficits for speech-in-noise and music streamingThe deficit affects stimuli presented on the left

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

Misophonia is characterized by an autonomic response (e.g., increased heart rate) that is elicited by certain innocuous or repetitive sounds, and individuals with misophonia may display an extreme, overt response commonly associated with rage, hatred, and a loss of self-control. In this investigation, we used a combined respondent and operant approach to treat problem behavior evoked by bodily sounds (i.e., coughing, sneezing, sniffling, and clearing throat) for an adult with autism spectrum disorder. The intervention produced immediate reductions of problem behavior and the effects of treatment maintained during progressively lean schedules of reinforcement. The results of this study will be discussed in light of past research, along with limitations, and future directions for research and clinical practice.

Misophonia is an understudied condition that is commonly viewed as an extreme sensitivity to specific soft sounds and visual stimuli which elicit strong negative emotions and physiological arousal. Recent research using self-report measures indicates that misophonia includes an elicited physical respondent (e.g. skeletal muscle flinch). Using electromyography (EMG) and direct observation, an immediate physical response to trigger stimuli was verified in three misophonic participants. Consistent movement of the body was observed in each subject when the subject reported having a moderate to strong response, though the location was unique for each subject. The response appeared to be immediate with the onset of a brief auditory stimulus and occurred at the start and throughout longer visual trigger stimuli. Additionally, an EMG measured response was consistent in one participant, and occurred in another participant when there was a strong self-reported response. Response latency for the EMG measured response was several hundred milliseconds, indicating the responses were elicited by the misophonic trigger stimulus and not general physiological arousal. This provides empirical evidence of an elicited physical response to misophonic stimuli in these individuals with misophonia. This supports conceptualization of misophonia as a condition which includes a respondent behavior (e.g. muscle flinch) elicited by the misophonic trigger stimulus. This highlights the need for additional research on the elicited physical response to misophonic stimuli and classical conditioning as a mechanism for the development of such a response.

Purpose-\ud \ud Meaningfully grouping individuals with tinnitus who share a common characteristics (ie, subgrouping, phenotyping) may help tailor interventions to certain tinnitus subgroups and hence reduce outcome variability. The purpose of this study was to test if the presence of tinnitus subgroups are discernible based on hearing-related comorbidities, and to identify predictors of tinnitus severity for each subgroup identified.\ud \ud Methods-\ud \ud An exploratory cross-sectional study was used. The study was nested within an online survey distributed worldwide to investigate tinnitus experiences during the COVID-19 pandemic. The main outcome measure was the tinnitus Handicap Inventory- Screening Version.\ud \ud Results-\ud \ud From the 3400 respondents, 2980 were eligible adults with tinnitus with an average age of 58 years (SD = 14.7) and 49% (n = 1457) being female. A three-cluster solution identified distinct subgroups, namely, those with tinnitus-only (n = 1306; 44%), those presenting with tinnitus, hyperacusis, hearing loss and/or misophonia (n = 795; 27%), and those with tinnitus and hearing loss (n = 879; 29%). Those with tinnitus and hyperacusis reported the highest tinnitus severity (M = 20.3; SD = 10.5) and those with tinnitus and no hearing loss had the lowest tinnitus severity (M = 15.7; SD = 10.4). Younger age and the presence of mental health problems predicted greater tinnitus severity for all groups (β ≤ −0.1, P ≤ .016).\ud \ud Conclusion-\ud \ud Further exploration of these potential subtypes are needed in both further research and clinical practice by initially triaging tinnitus patients prior to their clinical appointments based on the presence of hearing-related comorbidities. Unique management pathways and interventions could be tailored for each tinnitus subgroup.

International audience; Misophonia is a condition where a strong arousal response is triggered when hearing specific human generated sounds, like chewing, and/or repetitive tapping noises, like pen clicking. It is diagnosed with clinical interviews and questionnaires since no psychoacoustic tools exist to assess its presence. The present study was aimed at developing and testing a new assessment tool for misophonia. The method was inspired by an approach we have recently developed for hyperacusis. It consisted of presenting subjects (n = 253) with misophonic, pleasant, and unpleasant sounds in an online experiment. The task was to rate them on a pleasant to unpleasant visual analog scale. Subjects were labeled as misophonics (n = 78) or controls (n = 55) by using self-report questions and a misophonia questionnaire, the MisoQuest. There was a significant difference between controls and misophonics in the median global rating of misophonic sounds. On the other hand, median global rating of unpleasant, and pleasant sounds did not differ significantly. We selected a subset of the misophonic sounds to form the core discriminant sounds of misophonia (CDS Miso). A metric: the CDS score, was used to quantitatively measure misophonia, both with a global score and with subscores. The latter could specifically quantify aversion towards different sound sources/events, i.e., mouth, breathing/ nose, throat, and repetitive sounds. A receiver operating characteristic analysis showed that the method accurately classified subjects with and without misophonia (accuracy = 91%). The present study suggests that the psychoacoustic test we have developed can be used to assess misophonia reliably and quickly. Misophonia, literally hatred of sound 1 , is a condition where subjects experience negative emotional reactions (e.g., irritation, anger and/or disgust) 2,3 and a strong autonomic arousal response when hearing specific "trigger" sounds 4,5. These triggers most often contain human generated mouth sounds (e.g., chewing and slurping), breathing and nose sounds (e.g., heavy breathing and sniffing), throat sounds (e.g., swallowing and throat clearing), but also repetitive sounds of objects operated by humans (e.g., pen clicking and keyboard typing) 2-4. In some cases, visual repetitive stimuli, like leg-rocking or finger tapping, can act as misophonic triggers, a phenomenon known as "misokinesia" 2-4. The physical characteristics of sounds (e.g., intensity and frequency) only partially influence the reaction of misophonics to triggers, rather it is their psychological profile, previous experience, and the context in which triggers are experienced that are the most important 1,4,6,7. For instance, experiencing triggers when one cannot escape from the situation (e.g., plane trip) worsens negative reactions 4. Also, eating and chewing sounds are less annoying when originating from babies or animals, as it is "not their fault" if they are generating them 4. Similarly, an individual's own chewing sounds do not trigger a reaction and are often used as a coping mechanism to "cancel out" incoming triggers 3,4. Other coping mechanisms include listening to music, walking away, avoiding social situations, using earplugs/headphones, and asking the originator of the trigger to stop 2-4. Prevalence reports of misophonia show large variability and range from 6% to 49.1% 8-10. These differ considerably due to the different assessment methods and criterion that were used to define misophonia. Besides, misophonia severity varies: Naylor et al. 10 found that 37%, 12% and 0.3% of medical students had mild, moderate, and severe symptoms, respectively. They suggested that misophonia affects many people mildly, but only a few severely. Misophonia can be accompanied by different comorbidities such as obsessive-compulsive personality traits, depression, and anxiety 2,3,8,11. Perfectionism 2 , neuroticism 2,3,12 , difficulties with emotion regulation 12 , and high interoceptive sensibility 5 are also observed. Generally, no audiological problems are detected (e.g., audiogram, loudness discomfort levels, and speech audiometry) 2,3 , and cases of tinnitus and hyperacusis are scarce (2% and

The extreme, unprecedented situations in the current COVID-19 pandemic are risk factors for psychosocial stress for the entire population. However, strict confinement had a particular impact on people suffering from misophonia and their families. Misophonia is a condition in which hearing certain sounds triggers intense anger, disgust and even severe autonomic nervous system responses. This prospective cohort study examined the impact of strict confinement (Spain, March 14–June 21, 2020) on a sample of 24 people (16 women and eight men) who had been diagnosed with moderate to extreme misophonia and were regularly attending a medical psychology center in Barcelona. The 3-month period of confinement caused general emotional maladjustment, distress, and a transitory crisis. Long-term biomonitoring of their heart variability rate (HRV) enabled to identify a significant increase in physiological arousal after the confinement period, which had already been recorded in a loss of cardiac coherence under basal rest/relaxation conditions. Certain auditory stimuli triggered adverse responses, lowered HRV scores, and an increased stress level and heart rate. Loss of cardiac coherence in their responses to these auditory stimuli (triggering mouth, nose and other sounds), as well as to non-triggering mouth, nose and other sounds was increased when compared to two assessments performed during the previous year. Despite the limited sample size, sex differences were observed in the incidence. Loss of cardiac coherence worsened with the severity of the misophonia. Most importantly, imagined or evoked triggering sounds, as well as real ones, were enough to cause the aversive responses, as displayed by the increased loss of cardiac coherence with respect to the at-rest basal level. A semi-structured interview revealed the exceptional nature of the situations, increased hyper-sensorial sensitivity, fear of being infected with or dying from COVID-19, the patients' coping strategies, and the difficulties and constraints they faced. Finally, the article gives recommendations for better management of misophonia. Improved knowledge of this disorder would help address the current lack of health and social care, hopefully preventing this shortfall's impact on social and affective relationships, which are particulary important for well-being now and in the coming periods of physical distancing measures.

Highlights • We found micro and macro-structural white matter alterations in misophonia. • Patients had greater white matter volumes in left frontal cortex. • Patients had lower averaged radial and mean diffusivities. • Voxel-wise comparison indicated widespread clusters of lower mean diffusivity., Misophonia is a condition in which specific ordinary sounds provoke disproportionately strong negative affect and physiological arousal. Evidence for neurobiological abnormalities underlying misophonia is scarce. Since many psychiatric disorders show white matter (WM) abnormalities, we tested for both macro and micro-structural WM differences between misophonia patients and healthy controls. We collected T1-weighted and diffusion-weighted magnetic resonance images from 24 patients and 25 matched controls. We tested for group differences in WM volume using whole-brain voxel-based morphometry and used the significant voxels from this analysis as seeds for probabilistic tractography. After calculation of diffusion tensors, we compared group means for fractional anisotropy, mean diffusivity, and directional diffusivities, and applied tract-based spatial statistics for voxel-wise comparison. Compared to controls, patients had greater left-hemispheric WM volumes in the inferior fronto-occipital fasciculus, anterior thalamic radiation, and body of the corpus callosum connecting bilateral superior frontal gyri. Patients also had lower averaged radial and mean diffusivities and voxel-wise comparison indicated large and widespread clusters of lower mean diffusivity. We found both macro and microstructural WM abnormalities in our misophonia sample, suggesting misophonia symptomatology is associated with WM alterations. These biological alterations may be related to differences in social-emotional processing, particularly recognition of facial affect, and to attention for affective information.

Objective Analyze a large sample with detailed clinical data of misophonia subjects in order to determine the psychiatric, somatic and psychological nature of the condition. Methods This observational study of 779 subjects with suspected misophonia was conducted from January 2013 to May 2017 at the outpatient-clinic of the Amsterdam University Medical Centers, location AMC, the Netherlands. We examined DSM-IV diagnoses, results of somatic examination (general screening and hearing tests), and 17 psychological questionnaires (e.g., SCL-90-R, WHOQoL). Results The diagnosis of misophonia was confirmed in 575 of 779 referred subjects (74%). In the sample of misophonia subjects (mean age, 34.17 [SD = 12.22] years; 399 women [69%]), 148 (26%) subjects had comorbid traits of obsessive-compulsive personality disorder, 58 (10%) mood disorders, 31 (5%) attention-deficit (hyperactivity) disorder, and 14 (3%) autism spectrum conditions. Two percent reported tinnitus and 1% hyperacusis. In a random subgroup of 109 subjects we performed audiometry, and found unilateral hearing loss in 3 of them (3%). Clinical neurological examination and additional blood test showed no abnormalities. Psychological tests revealed perfectionism (97% CPQ>25) and neuroticism (stanine 7 NEO-PI-R). Quality of life was heavily impaired and associated with misophonia severity (rs (184) = -.34 p = < .001, p = < .001). Limitations This was a single site study, leading to possible selection–and confirmation bias, since AMC-criteria were used. Conclusions This study with 575 subjects is the largest misophonia sample ever described. Based on these results we propose a set of revised criteria useful to diagnose misophonia as a psychiatric disorder.

The aim of the article is to take a short reflection on the issue concerning the psychological aspects of sound sensitivity – expressed in the phenomenon of misophony and phonophobia. The following description was briefly described: hyperacusis, phonophobia and misophonia, and melophobia, indicating the basic symptoms of disorders in a psychological context.

The present study aimed to investigate the extent to which the severity of misophonia symptoms is linked with cognitive control under misophonia symptom-provocation circumstances in the general population sample. Participants (N = 79) completed a measure of cognitive control-a Stroop color naming task, which consists of congruent and incongruent stimuli, and requires inhibition of a prepotent response (reading a word) in the service of a less predominant response (naming a color), while listening to misophonia symptom-provocation or universally unpleasant sounds. Participants' misophonia sound sensitivity, and emotional behaviors towards trigger sounds were assessed using the Misophonia Questionnaire. Stronger emotional behavioral reactions to misophonia trigger sounds were significantly associated with the larger Stroop effect when participants were exposed to the misophonia trigger sounds, but not when they were exposed to the universally unpleasant sounds. This effect held when controlling for the personality trait of Neuroticism and for baseline levels of anxiety. Both elevated misophonia sound sensitivity and emotional behaviors towards trigger sounds significantly correlated with higher self-reported anxiety when performing the Stroop task. However, only elevated emotional behaviors towards trigger sounds were linked with higher anxiety levels at baseline, suggesting that people who experience stronger emotions and behavioral reactions to misophonia trigger sounds may have higher anxiety at a trait level. Limitations and future directions are discussed.

Introduction: Misophonia is characterized by the aversion to very selective sounds, which evoke a strong emotional reaction. It has been inferred that misophonia, as well as tinnitus, is associated with hyperconnectivity between auditory and limbic systems. Individuals with bothersome tinnitus may have selective attention impairment, but it has not been demonstrated in case of misophonia yet. Objective: To characterize a sample of misophonic subjects and compare it with two control groups, one with tinnitus individuals (without misophonia) and the other with asymptomatic individuals (without misophonia and without tinnitus), regarding the selective attention. Methods: We evaluated 40 normal-hearing participants: 10 with misophonia, 10 with tinnitus (without misophonia) and 20 without tinnitus and without misophonia. In order to evaluate the selective attention, the dichotic sentence identification test was applied in three situations: firstly, the Brazilian Portuguese test was applied. Then, the same test was applied, combined with two competitive sounds: chewing sound (representing a sound that commonly triggers misophonia), and white noise (representing a common type of tinnitus which causes discomfort to patients). Results: The dichotic sentence identification test with chewing sound, showed that the average of correct responses differed between misophonia and without tinnitus and without misophonia (p = 0.027) and between misophonia and tinnitus (without misophonia) (p = 0.002), in both cases lower in misophonia. Both, the dichotic sentence identification test alone, and with white noise, failed to show differences in the average of correct responses among the three groups (p ≥ 0.452). Conclusion: The misophonia participants presented a lower percentage of correct responses in the dichotic sentence identification test with chewing sound; suggesting that individuals with misophonia may have selective attention impairment when they are exposed to sounds that trigger this condition. Resumo: Introdução: A misofonia é caracterizada pela aversão a certos sons muito seletivos, que evocam uma forte reação emocional. Tem sido demonstrado que a misofonia, bem como o zumbido, está associada à hiperconectividade entre os sistemas auditivo e límbico. Indivíduos com zumbido incômodo podem ter comprometimento da atenção seletiva, mas isso ainda não foi demonstrado em caso de misofonia. Objetivo: Caracterizar uma amostra de indivíduos misofônicos e compará-la com dois grupos controle, um com indivíduos com zumbido (sem misofonia) e o outro com indivíduos assintomáticos (sem misofonia e sem zumbido) em relação à atenção seletiva. Método: Avaliamos 40 participantes com audição normal: 10 com misofonia, 10 com zumbido (sem misofonia) e 20 sem zumbido e sem misofonia. Para avaliar a atenção seletiva, o teste de identificação de sentenças dicóticas foi usado em três situações: no primeiro, aplicou-se o teste em português do Brasil. Então, o mesmo teste foi aplicado em duas outras situações, combinado com dois sons competitivos: som de mastigação (representa um som que geralmente desencadeia misofonia) e ruído branco (representa um tipo comum de zumbido que causa desconforto nos pacientes). Resultados: No teste de identificação de sentenças dicóticas com som de mastigação, observou-se que a média de respostas corretas diferiu entre os grupos misofonia e sem zumbido e sem misofonia (p = 0,027) e entre misofonia e zumbido (sem misofonia) (p = 0,002) e, em ambos os casos, foi menor em misofonia. Em relação ao teste feito isoladamente e com ruído branco, nenhuma diferença foi observada na média das respostas corretas nos três grupos (p ≥ 0,452). Conclusão: Os participantes do grupo misofonia apresentaram uma menor porcentagem de respostas corretas no teste de identificação de sentenças dicóticas com som de mastigação, sugeriu que indivíduos com misofonia podem ter comprometimento da atenção seletiva quando expostos a sons que desencadeiam a condição. Keywords: Misophonia, Tinnitus, Hyperacusis, Selective attention, Auditory processing, Palavras-chave: Misofonia, Zumbido, Hiperacusia, Atenção seletiva, Processamento auditivo

Objective: Misophonia is a newly described condition in which specific ordinary sounds provoke disproportionately strong negative affect. Since evidence for psychobiological dysfunction underlying misophonia is scarce, we tested whether misophonia patients, like many patients with impulse control or obsessive-compulsive spectrum disorders, show impaired ability to inhibit an ongoing motor response.Methods: We collected functional magnetic resonance imaging data during a stop signal task in 22 misophonia patients and 21 matched healthy controls.Results: Compared to controls, patients tended to show longer stop signal delays, which is the time between stimuli signaling response initiation and inhibition. Additionally, patients tended to activate left dorsolateral prefrontal cortex more during responding rather than successful inhibition, as was seen in controls. Furthermore, patients lacked inhibition success-related activity in posterior cingulate cortices and activated the superior medial frontal gyri less during inhibition success compared to failure, a feature correlated with stop signal delays over the sample.Conclusions: Misophonia patients did not show impaired response inhibition. However, they tended to show a response bias on the stop signal task, favoring accuracy over speed. This implies perfectionism and compulsive, rather than impulsive, behavior. Moreover, brain activations were in line with patients, compared to controls, engaging more cognitive control for slowing responses, while employing more attentional resources for successful inhibition.

Gürültünün insan sağlığı üzerinde olumsuz etkiler yarattığı bilinmektedir. Bu etkiler işitsel ve işitsel olmayan problemler şeklinde ortaya çıkmaktadır. Bu sorunlardan bir tanesi de mizofonidir. Gürültüden rahatsız olma şeklinde açıklanan mizofoni literatürde ayrıntılı olarak açıklanmış bir konu değildir. Bu nedenle oldukça sınırlı sayıda araştırma bulunmaktadır. Bununla birlikte mizofoni hastalarının fizyolojik bulgularının araştırıldığı çok az sayıda çalışma vardır. Bu nedenle çalışmanın amacı mizofoni belirtileri gösteren ve göstermeyen kişilerin SISI testi sonuçlarının karşılaştırılmasıdır. Çalışmaya 18-50 yaş arasında mizofoni belirtisi gösteren ve göstermeyen 15'er kişi gönüllü olarak katılmıştır. Katılımcılara Amsterdam Mizofoni Ölçeği uygulanmış, otoskopik muayene ve odyolojik değerlendirme yapılmış ve ardından SISI testi uygulanmıştır.Analiz sonuçlarına göre mizofoni belirtisi gösteren bireylerle belirti göstermeyen bireyler arasında SISI Testi skorları, Saf Ses Odyometre değerlendirmesi ve Tedirgin Edici Ses Yüksekliği arasında istatistiksel olarak anlamlı bir fark bulunamamıştır. Anahtar Kelimeler: Mizofoni, Odyoloji, SISI Testi, İşitme. Noise is known to have negative effects on human health. These effects occur in the form of auditory and non-auditory problems. One of these problems is known as misophonia. Misophonia, which is defined as being disturbed by noise, is not a subject that is explained in literature in detail. Therefore, there is very limited research. However, there are very few studies investigating the physiological findings of patients with misophonia.Therefore, the aim of the study was to compare the SISI test results of individuals with and without symptoms of misophonia. 30 people between the ages of 18-50 with and without signs of misophonia participated voluntarily. Amsterdam Misophonia Scale was applied to the participants, otoscopic and audiological examination was performed and then SISI test was applied.According to results of analysis, there is no significant difference between the individuals with and without misophonia symptoms in terms of SISI test, Pure Tone Audiometry evaluation and Uncomfortable Loudness Level scores.Key Words: Misophonia, Audiology, SISI Test, Hearing. 68

Misophonia is characterized by intense rage and disgust provoked by hearing specific human sounds resulting in social isolation due to avoidance. We exposed patients with symptom provoking audiovisual stimuli to investigate brain activity of emotional responses. 21 patients with misophonia and 23 matched healthy controls were recruited at the psychiatry department of the Amsterdam UMC. Participants were presented with three different conditions, misophonia related cues (video clips with e.g. lip smacking and loud breathing), aversive cues (violent or disgusting clips from movies), and neutral cues (video clips of e.g. someone meditating) during fMRI. Electrocardiography was recorded to determine physiological changes and self-report measures were used to assess emotional changes. Misophonic cues elicited anger, disgust and sadness in patients compared to controls. Emotional changes were associated with increases in heart rate. The neuroimaging data revealed increased activation of the right insula, right anterior cingulate cortex and right superior temporal cortex during viewing of the misophonic video clips compared to neutral clips. Our results demonstrate that audiovisual stimuli trigger anger and physiological arousal in patients with misophonia, associated with activation of the auditory cortex and salience network.

Misophonia is described as a condition in which negative emotions and negative physical reactions are triggered by particular sounds. The patients with misophonia demonstrate hatred and extreme intolerance against specific non-dominant and repetitive sounds. It is a severe psychiatric disorder rather than a mere obsession. Its symptoms may vary from mild to severe. Although some patients can dissemble and passed out, some may lose their control. In severe cases, involuntary physical violence may be observed. Although it is usually perceived as a spoil by the society, it may cause the patient’s life become unbearable. In this paper, the physical violence of a misophonia patient directed to a dinner guest who smacks his mouth during eating was reported. Unfortunately, the patient could not achieve to exclude himself from the source of disturbance before exhibiting the adverse physical reaction. Therefore, this case becomes important in demonstrating the extreme involuntarily reactive nature of misophonia.

(1) Background: Decreased sound tolerance is a significant problem in tinnitus sufferers. The aim of the study was to evaluate the relationship between tinnitus and decreased sound tolerance (hyperacusis and misophonia). (2) Methods: The study sample consisted of 74 patients with tinnitus and decreased sound tolerance. The procedure comprised patient interviews, pure tone audiometry, impedance audiometry, measurement of uncomfortable loudness levels, and administration of the Hyperacusis Questionnaire, Tinnitus Handicap Inventory, and Visual Analogue Scales. (3) Results: The majority (69%) of the patients reported that noise aggravated their tinnitus. The correlation between tinnitus and hyperacusis was found to be statistically significant and positive: r = 0.44, p &lt, 0.01. The higher the tinnitus severity, the greater the hyperacusis. There was no correlation between misophonia and hyperacusis (r = 0.18, p &gt, 0.05), or between misophonia and tinnitus (r = 0.06, 0.05). (4) Conclusions: For tinnitus patients the more significant problem was hyperacusis rather than misophonia. The diagnosis and treatment of decreased sound tolerance should take into account not only audiological, but also psychological problems of the patients.

Misophonia is a condition in which a person has an acute emotional response of anger or disgust to a commonly occurring innocuous auditory or visual stimulus referred to as a trigger. This case details the effective treatment of misophonia in a young woman that included a counterconditioning treatment called the Neural Repatterning Technique (NRT), which combines a continuous positive stimulus and a reduced intensity, intermittent trigger. The treatment was delivered via the Misophonia Trigger Tamer smartphone app and all treatments were conducted independently by the patient. In this patient, the trigger elicited a physical reflex of contraction of the flexor digitorum profundus, which caused her to clench her fist. To enhance the effect of the NRT treatment, Progressive Muscle Relaxation was incorporated to increase her ability to deliberately relax the affected muscle during treatment. During NRT treatment sessions, the patient experienced a weak physical reflex to the reduced trigger stimulus but no emotional response. Her emotional response of misophonia was not treated, but when the physical reflex extinguished, the emotional response also extinguished. This case indicates that the misophonic response includes a Pavlovian-conditioned physical reflex. It is proposed that the trigger elicited the physical reflex and the physical reflex then elicited the conditioned emotional response that is characteristic of misophonia. Because of the conditioned reflex nature of misophonia, it is proposed that a more appropriate name for this disorder would be Conditioned Aversive Reflex Disorder.

We propose that cross-sensory stimuli presenting a positive attributable source of an aversive sound can modulate negative reactions to the sound. In Experiment 1, participants rated original video sources (OVS) of eight aversive sounds (e.g., nails scratching a chalkboard) as more aversive than eight positive attributable video sources (PAVS) of those same sounds (e.g., someone playing a flute) when these videos were presented silently. In Experiment 2, new participants were presented with those eight aversive sounds in three blocks. In Blocks 1 and 3, the sounds were presented alone; in Block 2, four of the sounds were randomly presented concurrently with their corresponding OVS videos, and the other four with their corresponding PAVS videos. Participants rated each sound, presented with or without video, on three scales: discomfort, unpleasantness, and bodily sensations. We found the concurrent presentation of videos robustly modulates participants’ reactions to the sounds: compared to the sounds alone (Block 1), concurrent presentation of PAVS videos significantly reduced negative reactions to the sounds, and the concurrent presentation of OVS videos significantly increased negative reactions, across all three scales. These effects, however, did not linger into Block 3 when the sounds were presented alone again. Our results provide novel evidence that negative reactions to aversive sounds can be modulated through cross-sensory temporal syncing with a positive attributable video source. Although this research was conducted with a neurotypical population, we argue that our findings have implications for the treatment of misophonia.

Background Autonomous Sensory Meridian Response (ASMR) is a sensory experience elicited by auditory and visual triggers, which so far received little attention from the scientific community. This self-reported phenomenon is described as a relaxing tingling sensation, which typically originates on scalp and spreads through a person’s body. Recently it has been suggested that ASMR shares common characteristics with another underreported condition known as misophonia, where sounds trigger negative physiological, emotional and behavioural responses. The purpose of this study was to elucidate whether ASMR is associated with heightened levels of misophonia. Methods The Misophonia Questionnaire (MQ) was administered to individuals reporting to experience ASMR and to age and gender matched controls. Results Compared to controls ASMR group scored higher on all subscales of MQ including the Misophonia Symptom Scale, the Misophonia Emotions and Behaviors Scale and the Misophonia Severity Scale. Discussion Individuals reporting ASMR experience have elevated levels of misophonia.

Objective: To assess the prevalence of hyperacusis and severe hyperacusis among children and adolescents seen at an audiology outpatient tinnitus and hyperacusis service. Design: This was a retrospective study. Hyperacusis was considered as present if the average uncomfortable loudness level (ULL) at 0.25, 0.5, 1, 2, 4 and 8 kHz for the ear with the lower average ULL, which is denoted as ULLmin, was ≤77 dB HL. Severe hyperacusis was considered as present if the ULL was 30 dB HL or less for at least one of the measured frequencies for at least one ear. Study sample: There were 62 young patients with an average age of 12 years (SD = 4.1 years, range 4–18 years). Results: Eighty-five percent of patients had hyperacusis and 17% had severe hyperacusis. On average, ULLs at 8 kHz were 9.3 dB lower than ULLs at 0.25 kHz. For 33% of patients, ULLs were at least 20 dB lower at 8 than at 0.25 kHz. Conclusions: Among children and adolescents seen at an audiology outpatient clinic for tinnitus and hyperacusis, hyperacusis diagnosed on the basis of ULLs is very prevalent and it is often characterised by lower ULLs at 8 than at 0.25 kHz.

This year marks 25 years of tinnitus retraining therapy (TRT), the approach that aims to eliminate tinnitus as a problem by extinguishing functional connections between the auditory and the limbic and autonomic nervous systems to achieve habituation of tinnitus-evoked reactions and subsequently habituation of perception. TRT addresses directly decreased sound tolerance (DST) as well as tinnitus. TRT consists of counseling and sound therapy, both based on the neurophysiological model of tinnitus. The main goal of retraining counseling is to reclassify tinnitus into the category of a neutral stimulus, while the main goal of sound therapy is to decrease the strength of tinnitus-related neuronal activity. A unique aspect of TRT is that because treatment is aimed to work above the tinnitus source, and at connections linking the auditory and other systems in the brain, the etiology of tinnitus is irrelevant. Any type of tinnitus, as well as somatosounds, can be successfully treated by TRT. Over 100 publications can be found on Medline when using "tinnitus retraining therapy" as a search term. The majority of these publications indicate TRT offers significant help for about 80 % of patients. A randomized clinical trial showing the effectiveness of TRT has been published and another large study is in progress. The principles of the neurophysiological model of tinnitus, and consequently TRT, have not changed in over 25 years of use, but a number of changes have been introduced in TRT implementation. These changes include the recognition of the importance of conditioned reflexes and the dominant role of the subconscious pathways; the introduction of the concept of misophonia (i.e., negative reactions to specific patterns of sound) and the implementation of specific protocols for its treatment; greater emphasis on the concurrent treatment of tinnitus, hyperacusis, misophonia, and hearing loss; extensive modification of counseling; and refinements in sound therapy. The effectiveness of TRT has increased significantly during the past 25 years, presumably due to changes incorporated in its implementation. The main improvement has been to shorten the average time until seeing clear improvement from 1 year to 1 month, with a statistically significant improvement seen at, and after, 3 months. Furthermore, there is a higher effectiveness and a shorter treatment time for DST and an increased extent of help for hearing loss.

Tinnitus and decreased sound tolerance are challenging clinical phenomena. Decreased sound tolerance consists of hyperacusis, in which negative reactions to a sound depend only on its physical characteristics, and misophonia, where negative reactions occur to sounds that have a specific pattern and meaning for a given subject. Tinnitus and decreased sound tolerance affect a substantial proportion of general population. They frequently coexist not only with each other but with hearing loss as well, and need to be treated concurrently to achieve a successful outcome. This article outlines potential mechanisms of tinnitus and decreased sound tolerance and describes their treatment, with an emphasis on the neurophysiological model of tinnitus and Tinnitus Retraining Therapy (TRT).

Decreased sound tolerance (DST) is an underappreciated condition that affects the lives of a significant portion of the general population. There is lack of agreement regarding definitions, specific components, prevalence, methods of evaluation, and methods of treatment. Limited data are available on the results of treatments. Research is scant and constrained by the lack of an animal model. This article proposes a definition of DST and its division into hyperacusis and misophonia. The potential mechanisms of these phenomena are outlined, and the results of treatment performed at Emory University are presented. Out of 201 patients with DST, 165 (82%) showed significant improvement. Of 56 patients with hyperacusis (with or without misophonia), 45 (80%) showed significant improvement. This proportion was higher for the group with hyperacusis and concurrent misophonia (33 of 39, or 85%) and lower for patients with hyperacusis only (13 of 17, or 76%). Effectiveness of treatment for misophonia with or without hyperacusis was identical (152 of 184, 83% and 139 of 167, 83%, respectively, for misophonia accompanied by hyperacusis and for misophonia only). Even with current limited knowledge of DST, it is possible to propose specific mechanisms of hyperacusis and misophonia and, based on these mechanisms, to offer treatments in accordance with the neurophysiological model of tinnitus. These treatments are part of Tinnitus Retraining Therapy (TRT), which is aimed at concurrently treating tinnitus and DST and alleviating the effects of hearing loss. High effectiveness of the proposed treatments support the postulated mechanisms.

The management of tinnitus, hyperacusis, and misophonia can be a challenge to the audiologist, physician, and psychologist, as well as the patient and their family. Assisting the patient in identifying cognitive distortions or misperceptions can aid in the transition from one who suffers from these conditions to one who is able to manage them. Although there is no cure, it is inappropriate to tell patients that nothing can be done. The audiologist can help the patient learn techniques to lower the emotional impact of tinnitus. For those with an interest in tinnitus and sound sensitivity management, many tools are available. Most importantly, knowing when to refer is paramount. Compiling a referral list of medical and allied health providers, as well as audiologists who specialize in tinnitus, hyperacusis, and misophonia management, is in the best interest of the patient. Being familiar with the ever increasing list of available products and devices is necessary to build the tinnitus toolbox. This article will review current treatments, trends, and tools that may assist in patient education and tinnitus habituation. Some attention also will be paid to other sound sensitivities such as hyperacusis and misophonia.

To evaluate the hearing status of growth hormone (GH)-naive adults with isolated GH deficiency (IGHD) belonging to an extended Brazilian kindred with a homozygous mutation in the GH-releasing hormone receptor gene.Cross-sectional.Divisions of Endocrinology and Otorhinolaryngology of the Federal University of Sergipe.Twenty-six individuals with IGHD (age, 47.6 ± 15.1 years; 13 women) and 25 controls (age, 46.3 ± 14.3 years; 15 women) were administered a questionnaire on hearing complaints and hearing health history. We performed pure-tone audiometry, logoaudiometry, electroacoustic immittance, and stapedial reflex. To assess outer hair cell function in the cochlea, we completed transient evoked otoacoustic emissions (TEOAEs). To assess the auditory nerve and auditory brainstem, we obtained auditory brainstem responses (ABRs).Misophonia and dizziness complaints were more frequent in those with IGHD than in controls (P = .011). Patients with IGHD had higher thresholds at 250 Hz (P = .005), 500 Hz (P = .006), 3 KHz (P = .008), 4 KHz (P = .038), 6 KHz (P = .008), and 8 KHz (P = .048) and mild high-tones hearing loss (P = .029). Stapedial reflex (P.001) and TEOAEs (P = .025) were more frequent in controls. There were no differences in ABR latencies. Hearing loss in patients with IGHD occurred earlier than in controls (P.001).Compared with controls of the same area, subjects with untreated, congenital lifetime IGHD report more misophonia and dizziness, have predominance of mild high-tones sensorineural hearing loss, and have an absence of stapedial reflex and TEOAEs.

Background: Those with misophonia experience distress in response to specific sounds (e.g., sounds of eating) and often to repetitive movements (e.g., seeing leg shaking). The literature on misophonia is sparse but it is gaining increased clinical attention. Methods: We report on four cases to highlight clinical characteristics associated with misophonia seen in a pediatric treatment setting. Results: Patients typically responded to triggers with avoidant behavior or made attempts to stop the production of the trigger. Misophonia caused varying levels of impairment and was often seen as the patient’s primary complaint. Onset began in childhood and demonstrated increasing severity until the point at which evaluation and treatment was sought. Family accommodation was consistently present and reinforced the patient’s difficulties. Conclusion: Misophonia is distinguished from existing psychological and auditory disorders that have known etiologies and treatments. Further research is required to understand the neurological and psychological underpinnings of the disorder, and identify appropriate treatments.

There are a number of auditory symptom syndromes that can develop without an organic basis. Some of these, such as nonorganic hearing loss, affect populations similar to those presenting with functional somatosensory and motor symptoms, while others, such as musical hallucination, affect populations with a significantly different demographic and require different treatment strategies. Many of these conditions owe their origin to measurably abnormal peripheral sensory pathology or brain network activity, but their pathological impact is often due, at least in part, to overamplification of the salience of these phenomena. For each syndrome, this chapter briefly outlines a definition, demographics, investigations, putative mechanisms, and treatment strategies. Consideration is given to what extent they can be considered to have a functional basis. Treatments are in many cases pragmatic and rudimentary, needing more work to be done in integrating insights from behavioral and cognitive psychology to auditory neuroscience. The audiology literature has historically equated the term functional with malingering, although this perception is, thankfully, slowly changing. These disorders transcend the disciplines of audiology, otorhinolaryngology, neurology and psychiatry, and a multidisciplinary approach is often rewarding.

© 2015 Barratt and Davis. Autonomous SensoryMeridian Response (ASMR) is a previously unstudied sensory phenomenon, in which individuals experience a tingling, static-like sensation across the scalp, back of the neck and at times further areas in response to specific triggering audio and visual stimuli. This sensation is widely reported to be accompanied by feelings of relaxation and well-being. The current study identifies several common triggers used to achieve ASMR, including whispering, personal attention, crisp sounds and slow movements. Data obtained also illustrates temporary improvements in symptoms of depression and chronic pain in those who engage in ASMR. A high prevalence of synaesthesia (5.9%) within the sample suggests a possible link between ASMR and synaesthesia, similar to that of misophonia. Links between number of effective triggers and heightened flow state suggest that flow may be necessary to achieve sensations associated with ASMR.