Misophonia

What is Misophonia?  

Dr. Pawel Jastreboff’s definition:

Misophonia  - abnormally strong negative reactions of the autonomic and limbic systems to specific sounds resulting from enhanced functional connections between the auditory and limbic systems for these sounds.  

The auditory system works in a normal manner, without abnormally high activation.   

At the behavioral level, sounds specific for a given patient evoke strong negative reactions.   

This situation may cause general negative attitude to sound as well.   

When fear is dominant emotion (patient is afraid of sound) phonophobia occurs (phobia - fear).  Phonophobia is a specific case of misophonia. 

Definition from the UK’s Misophonia Site:

misophonia
Fear or hatred of certain (or all) sounds. A term coined by US scientists Pawel and Margaret Jastreboff in 2001. Misophonia, SSSS, phonophobia and hyperacusis are often used interchangeably which is not helpful to definitional clarity. Misophonia UK's position is that:
● misophonia should be used to refer to a dislike of some, or all, sounds. 

Two apparently distinct kinds of misophonia are loud sound misophonia (LSM) and soft sound misophonia (SSM), better known as selective sound sensitivity sydrome or 4S.
● selective sound sensitivity should be considered a type of misophonia, where soft sounds (typically eating and breathing sounds made by emotional attachment figures) are the focus, and the quality of those sounds causes annoyance and rage in the listener.

MEDICAL DICTIONARY DEFINITION

misophonia

Type: Term
Pronunciation: mis-ō-fō′nē-ă

Definitions:
1. Dislike of sound.

Dr. Johnson, AuD Site www.hyperacusis.org : 

Misophonia: Dis-Like of Sounds, finding sound itself or particular sounds, aggravating or overwhelming, a feeling of sensory overload or over-stimulation, this can lead to self-isolation, removal from noisy environments, using earplugs often, withdrawing from work or social situations, avoiding sounds or noises.

 

Selective Soft Sound Sensitivity (4S):   A variant of misophonia that includes only very soft particular noises, called Trigger Sounds, most often sounds associated with oral functions such as chewing, lip licking, smacking, or breathing

MECHANISMS OF MISOPHONIA:  THEORIES

Dr. Hazell: (website on hyperacusis and misophonia)

 Hyperacusis is due to an alteration in the central processing of sound in the auditory pathways where there is an abnormally strong reaction from exposure to moderate sound levels. 

The cochlea is often completely normal, although patients frequently wrongly believe it is irreversibly damaged. 

Traditional teaching involved only an understanding of 'recruitment' , the result of cochlea damage. 

Since all people with hyperacusis can be helped by a behavioural approach with 'sound' therapy, it has become clear that the symptoms cannot be the result of irreversible ear damage. 

Another reason for sound sensitivity is misophonia. 

This means a dislike of being exposed to a certain sound. 

Here the auditory pathways may be functioning normally, but there is an abnormally strong reaction of the limbic (emotional system) and autonomic nervous system (body control system) to which the auditory system is intimately connected.

Drs. Hughes and Pensak (Clinical Otology Textbook) 2007

Misophonia can be considered abnormally strong connections between the autonomic and limbic resulting from enhanced connections between the auditory and limbic systems.   

These connections encompass both a high level of cortical level loop with involvement with cognition as well as subconscious connections, most probably involving the link between the medial geniculate body and the amygdale. 

The functions of these connections are governed by the principles of conditioned reflexes.

WHY DOES MISOPHONIA AFFECT US SO STRONGLY?

Dr. Hazell: 

The process of developing an increased sensitivity to specific sound always involves the limbic system and autonomic nervous system. 

Where phonophobia or misophonia exists there is an inevitable association of fear or dislike, associated with the appearance of the sound, whenever it occurs. 

The attentional focus becomes filled with that sound, so that interference with concentration (on another task) occurs. 

These conditioned responses act like survival reflexes and have to carry a message of unpleasant emotion, in order to ensure that a response occurs. 

They also stimulate the autonomic nervous system to prepare us for 'flight or fight' so there may be coincident increases in heart rate, sweating, muscle tension, and other adrenaline-mediated body responses

WHAT ARE THE MOST TYPICAL RESPONSES:  (Johnson, survey 2009)

·        

    Anger, rage, irritation, annoyance

·       Anxiety, urge to flee, escape environment (flight)

·       Depression, self-hatred, shame, negative self image, emotional

·       Need to strike back, physically or using mimicking sounds or noises

WHAT IS THE MOST COMMON AGE OF ONSET:  *Johnson, surveys 2004, 2009

            Pre puberty seems to be a very common age of onset for the majority of those with misophonia, with lifetime persistence for most cases, and there appears to be a genetic component

WHAT MEDICAL PROVIDERS MIGHT BE SEEN FOR MISOPHONIA?

1.    Primary care MDs, to rule out any other diseases or illness

2.    Ear Nose & Throat Physician, to examine auditory system

3.    Audiologist, to examine auditory system, evaluate treatment

4.    Psychologist, to examine for phobias, emotional or mental health issues, set up a cognitive behavioral therapy approach as part of a team, address other issues as they arise, provide mindfulness or other therapies

5.    Psychiatrist, to evaluate use of bio-chemicals for other conditions related to psychiatric findings, assessments for other issues

6.    Counselors, to provide ongoing support and therapy for sufferer and family

7.    Alternative healthcare providers to assist with a variety of healthful or health promoting treatments or therapies

WHAT MIGHT BE INCLUDED IN A MISOPHONIA ASSESSMENT?

• ·       General physical, bloodwork to rule out any problems

• ·       Detailed case history by every provider

• ·       Most will visit ENT, and audiologist, these visits can include:
•  visual inspection of ear canals, 
• assessment of the auditory system including a hearing test using air and bone conduction, 
• tympanometry to examine middle ear function, 
• speech tests to examine processing of language sounds, 
• loudness discomfort level (LDL) tests using voice, tones, noise or other sounds. 
• The new Misophonia Assessment Questionnaire (MAQ) should be completed by the patient or a parent

• ·       Interview with Psychologist or Counselor using a variety of assessment tools to define condition and symptoms.

• ·       Trials of various medications is commonly included for misophonics which may include anti anxiety, anti OCD, mood elevators or sleep medications

WHAT ARE TREATMENTS FOR MISOPHONIA?

·        Tinnitus retraining therapy has been tried using bilateral sound generators and directive counseling

·        Earplugs are often prescribed to help block out intruding sounds

·        Cognitive therapy

·        Desensitization therapies including adversive exposure therapy, sensory integration auditory programs, and many others

·        Counseling therapies

·        Rotating cycles of pleasant sound therapy paired with unpleasant sounds

·        Psychoanalysis

IS THERE A GOLD STANDARD TREATMENT FOR MISOPHONIA?

No.  We are working on developing such a protocol.   

Right now we have two possible programs, one that uses audiologists as the primary service providers and using a new sound therapy, and a second approach that combines psychological counseling (CBT) with the use of pleasant sound stimuli.

WHAT TO DO NEXT:

Contact a regional center and arrange for a full misophonia evaluation. The qualified providers will assist you in discovering what can be done to improve your situation.

Fuente: www.misophonia-provider.com