A small group of audiologists are looking into this curious area

It’s easy to dismiss complaints about misophonia because we all have, to some degree, a laundry list of sounds we “simply can’t stand.” However, a small subset of people actually have a lifealtering problem with trigger sounds that cause “fight or flight” responses, resulting in outbursts and/or causing them to avoid and miss out on important parts of life. A group of audiologists have recently been working on the evaluation and treatment of people with misophonia, drawing from our field’s knowledge of tinnitus and sound therapy.

Misophonia is a new word for many of us. The term was introduced by Pawel Jastreboff, PhD, over a decade ago. He described it as a subtype of decreased sound tolerance. Is it a psychological disorder or a hearing disorder or both? Psychologists, hearing care professionals, as well as physicians have often dismissed it or are at a loss of what to do with patients reporting this puzzling set of symptoms. Yet it is a real problem, and many of us believe we can no longer ignore it.

Dhyan Cassie, AuD, is coordinator of the Tinnitus/Hyperacusis Center at Ear Nose and Throat Professional Associates in Haddonfield, NJ, and an adjunct professor at the Arizona School of Health Sciences. Correspondence can be addressed to Dr Cassie at:

The word misophonia means hatred of sound. These are not necessarily loud sounds. Misophonia is different from recruitment and hyperacusis, which are related to loud sounds. Patients with misophonia cannot tolerate certain sounds, which usually involve some mouth movements—eating, gum chewing, clicking, swallowing, slurping, coughing, and certain sibilant sounds. It also may include other repetitive sounds, such as finger tapping or key boarding. At times, the reaction is limited to certain persons, often a parent or sibling, who are making the annoying sounds.

The misophonic patient often cannot eat with their families or go out to restaurants. It has caused significant stress in family dynamics. Children have been known to drop out of school for fear of being confronted by these trigger sounds. Adults have had to avoid social occasions.

Psychology or Audiology? Misophonia Options

Misophonia often begins during childhood at age 8 or 9. It also may start earlier for some and later for others. Psychologists search for a precipitating factor; audiologists search for a hearing problem. Until we find answers, these patients are left in limbo.

As hearing care professionals, we can play a part in helping these patients try to normalize their lives. First, we need to take the problem seriously. This is not a made-up problem. People from all over the world report the same series of complaints and the same strong reactions to their particular aversive sounds.

Second, we can offer help. We know from working with tinnitus patients that the real problem is not peripheral, but central. There is an evaluation in the auditory cortex that sends the information to the limbic system, and the reaction is anxiety, fear, and even violence.

We know the brain is plastic and can be reorganized. Most aversive sound stimuli can be habituated with the proper counseling and intervention.

A small group of audiologists are working together to find the most effective auditory therapies for these patients. Marsha Johnson, AuD, has been working with misophonic patients for 15 years. The others in the group have become aware of this problem more recently. A protocol of evaluation and treatment is still in progress.

To date, patients are given a Misophonia Reaction Questionnaire and are enrolled in a Misophonia Management Protocol. Sound therapy is the component that is used for desensitization. Different forms of sound therapy are being used, such as pink noise, brown noise, fractal music, music, and narrow-band noise. These may be delivered via wearable sound generators, iPods, or other MP3 players. Sound is not used for masking; it’s used for increasing contrast with quiet surroundings so that the trigger sounds may not stand out as dramatically.

It is important the patient also receives cognitive behavioral therapy (CBT). It is possible that one can learn a new reaction to these triggers. The positive reinforcement using CBT and sound therapy has been helping patients. There is still data to collect to determine which sound therapy may be most helpful, and this continues to be a work in progress. However, we believe it is a problem that has been denied attention for too long.

Citation for this article:

Cassie D. Misophonia: Beyond Irritation to a Hatred and Aversion of Sound Hearing Review. 2012;19(05):52-53.