MISOPHONIA: THE PHENOMENON MAKING SOME SOUNDS INTOLERABLE What is misophonia? Misophonia, derived from the Greek words miso “hatred” and phonia “sound,” is when individuals have a strong, negative, emotional reaction to specific sounds, known as triggers. Misophonia is characterized by intense reactions—such as anger, anxiety, or disgust— triggered by repetitive sounds like chewing or breathing, regardless of their volume. This reaction often activates the sympathetic nervous system’s fight-or-flight response. How do you assess/diagnose someone with misophonia? Assessing misophonia involves distinguishing it from other sound-tolerance issues. Specialized tools like the Sound Tolerance Interview and targeted misophonia questionnaires, such as the validated Duke Misophonia Questionnaire, are used to gauge severity and monitor treatment progress. What is the difference between misophonia and hyperacusis? Hyperacusis involves an increased central gain in auditory pathways, leading to discomfort or pain from moderate to loud sounds. In contrast, misophonia is associated with abnormal connectivity and hyperactivity in the brain’s salience and emotional processing networks. Functional MRI studies have shown abnormal connectivity between the anterior insular cortex and emotion-regulation regions (e.g., the ventromedial prefrontal cortex and amygdala) and heightened activation in the anterior insula and anterior cingulate cortex, which are key to emotional processing and salience detection (Kumar et al., 2017; Neacsiu et al., 2022). What are the current interventions for misophonia? Treatment for misophonia typically involves an interdisciplinary approach. One expert suggests increasing exposure to positive sounds and pairing them with negative triggers to neutralize reactions. For many, additional therapies are needed to rewire the heightened responses to triggers. Emerging treatments like mindfulness meditation could also be beneficial, as they may improve the function of the salience network involved in heightened sound awareness. Department of Audiology—Fort Lauderdale Sarah Wakefield, Au.D., associate professor (right), confers with third-year audiology student Carly Kosciolek regarding misophonia treatment. 5
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