Properties (15)
Id 0e15b877-2eed-4a8e-a781-abe0f66816f5
Year 2022
Abstract This paper evaluates the proportion and the audiological and other characteristics of patients with symptoms of misophonia among a population seeking help for tinnitus and/or hyperacusis at an audiology clinic (n = 257). To assess such symptoms, patients were asked “over the last 2 weeks, how often have you been bothered by any of the following problems? Feeling angry or anxious when hearing certain sounds related to eating noises, lip-smacking, sniffling, breathing, clicking sounds, tapping?”. The results of routine audiological tests and self-report questionnaires were gathered retrospectively from the records of the patients. Measures included: pure tone audiometry, uncomfortable loudness levels (ULLs), and responses to the tinnitus impact questionnaire (TIQ), the hyperacusis impact questionnaire (HIQ), and the screening for anxiety and depression in tinnitus (SAD-T) questionnaire. The mean age of the patients was 53 years (SD = 16) (age range 17 to 97 years). Fifty four percent were female. Twenty-three percent of patients were classified as having misophonia. The presence and frequency of reporting misophonia symptoms were not related to audiometric thresholds, except that a steeply sloping audiogram reduced the likelihood of frequent misophonia symptoms. Those with more frequent misophonia symptoms had lower values of ULLmin (the across-frequency average of ULLs for the ear with lower average ULLs) than those with less frequent or no reported symptoms. The reported frequency of experiencing misophonia symptoms increased with increasing impact of tinnitus (TIQ score ≥9), increasing impact of hyperacusis (HIQ score >11), and symptoms of anxiety and depression (SAD-T score ≥4). It is concluded that, when assessing individuals with tinnitus and hyperacusis, it is important to screen for misophonia, particularly when ULLmin is abnormally low or the TIQ, HIQ or SAD-T score is high. This will help clinicians to distinguish patients with misophonia, guiding the choice of therapeutic strategies.
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- (Aazh et al., 2022)
Import Date 04-14-2026
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Dv Authors Hashir Aazh, Mercede Erfanian, Ali A. Danesh, Brian C. J. Moore,
Dv Initial Source Misophonia MOC
Dv Status #status/reviewed
Dv Limitations • Misophonia assessed using only one questionnaire item (SSSQ4); no validated misophonia-specific questionnaire administered. • Validity and reliability of SSSQ4 as a misophonia measure have not been formally evaluated. • Retrospective design limited measures to those collected as part of routine care. • ULL measurement cap at 80 dB HL may have attenuated the observed between-group difference in ULLmin; true group differences are likely underestimated. • Sample restricted to audiology clinic patients with tinnitus and/or hyperacusis; findings not generalizable to the general population or mental health service populations.
Dv Future Directions • Use validated misophonia-specific questionnaires (e.g., MisoQuest, Amsterdam Misophonia Scale, Duke Misophonia Questionnaire) in future studies examining relationships with audiological variables. • Investigate history of various adverse childhood experiences (abuse, neglect, household dysfunction) in patients with misophonia. • Explore the directionality of the association between misophonia and psychiatric disorders; specifically, whether pre-existing misophonia increases risk of psychiatric comorbidity. • Examine psychoacoustic and electrophysiological characteristics of the auditory system in patients with misophonia to address gaps in understanding of auditory function in this population.• Use validated misophonia-specific questionnaires (e.g., MisoQuest, Amsterdam Misophonia Scale, Duke Misophonia Questionnaire) in future studies examining relationships with audiological variables. • Investigate history of various adverse childhood experiences (abuse, neglect, household dysfunction) in patients with misophonia. • Explore the directionality of the association between misophonia and psychiatric disorders; specifically, whether pre-existing misophonia increases risk of psychiatric comorbidity. • Examine psychoacoustic and electrophysiological characteristics of the auditory system in patients with misophonia to address gaps in understanding of auditory function in this population.
Dv Relevance • a good source for info looking at the relationship of misophonia with various hearing issues. • brings up interesting points about how specific sounds with certain energies are universally unpleasant, and this range composes a lot of triggers • they also bring up the idea that hearing changes could impact miso severity, i.e hearing loss in certain range would decrese perception of some triggers. but also loudness recruitment could exacerbate misophonia. • this could use a deeper review should we need an audiology approach to things.
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Audiological and Other Factors Predicting the Presence of Misophonia Symptoms Among a Clinical Population Seeking Help for Tinnitus and/or Hyperacusis
Status:: #status/reviewed
Metadata
- Item Type: #journalArticle
- Authors:: Hashir Aazh, Mercede Erfanian, Ali A. Danesh, Brian C. J. Moore,
- Date:
- Date Added: 1697222494000
- URL: https://www.frontiersin.org/articles/10.3389/fnins.2022.900065/full
- DOI: 10.3389/fnins.2022.900065
- Cite Key: aazhAudiologicalOtherFactors2022
- Topics: [object Object],[object Object]
- Tags:: #Misophonia, #reviewed, #clinical, #hearing-loss, #uncomfortable-loudness-levels, #tinnitus, #Hyperacusis,
- PDF Attachments
Abstract
| Background/Purpose | Background- • Misophonia, hyperacusis, and tinnitus frequently co-occur, yet audiological profiles of patients with misophonia are poorly characterized in the literature. • Most misophonia research originates from psychiatry and neuroscience, with minimal audiological evaluation of study populations. • In audiology, misophonia has often been subsumed under hyperacusis rather than treated as a distinct condition, limiting condition-specific data. • Prevalence of misophonia in the general population ranges from 6–37% depending on population and assessment method; rates in clinical audiology populations are unknown. • Misophonia co-occurs with affective disorders (MDD, OCPD, PTSD) and developmental disorders (ADHD, ASD); diagnostic complexity arises from overlapping symptomology. • Published studies have not examined relationships between audiological variables (audiometric thresholds, ULLs) and misophonia symptoms. • Theoretical basis exists for hearing loss influencing misophonia: high-frequency loss could reduce audibility of trigger sounds, while loudness recruitment could increase sensitivity in those with hearing loss. • Between-ear asymmetry in HTLs or ULLs has not been investigated among patients with misophonia despite some evidence of asymmetrical ULLs in severe hyperacusis. • The relationship between severity of tinnitus/hyperacusis impact and likelihood of misophonia symptoms has not been previously examined. Purpose- • Assess the proportion of patients with misophonia symptoms among a clinical population seeking help for tinnitus and/or hyperacusis. • Compare audiological characteristics (audiometric thresholds, ULLs) and severity of tinnitus, hyperacusis, anxiety, and depression across patients reporting different frequencies of misophonia symptoms. • Identify audiological and psychosocial predictors of misophonia symptom presence using regression modeling to inform clinical screening practices. |
| Participants/samples | • N = 257 adults attending a specialist Tinnitus and Hyperacusis Therapy Specialist Clinic (THTSC), Royal Surrey NHS Foundation Trust, Guildford, UK, during 2019–2020. • Mean age = 53 years (SD = 16); range 17–97 years; 54% female. • All patients were seeking help for tinnitus and/or hyperacusis and completed the misophonia screening item as part of routine care. • Retrospective cross-sectional design; data extracted from clinical records. • Ethical approval granted as clinical audit; patient consent waived. |
| Measures | • Pure tone audiometry (HTLs at 0.25, 0.5, 1, 2, 3, 4, 6, 8 kHz bilaterally); BSA procedure with discomfort-limiting modifications. • PTA severity categories: mild (20–40 dB HL), moderate (41–70), severe (71–95), profound (>95), based on better-ear PTA across 0.25–4 kHz. • HTL slope: absolute difference between HTLs at 8 kHz and 1 kHz per ear. • Between-ear PTA difference: classified into five asymmetry bands (<5, 5–10, 10–20, 20–30, ≥30 dB). • ULLs measured bilaterally at 0.25–8 kHz; BSA procedure with cap at 80 dB HL (ULL recorded as 85 dB HL if threshold not reached); ULLmin computed as across-frequency average for lower-ULL ear. • ULL slope: absolute difference in ULLs between 8 and 1 kHz per ear. • Between-ear ULL difference: classified as symmetrical (<5 dB), mildly asymmetrical (5–<10 dB), or asymmetrical (≥10 dB). • SSSQ item 4 (SSSQ4): single-item misophonia screen; 4-point response scale (0–1, 2–6, 7–10, 11–14 days); dichotomized into Miso Cat 0 (scores 0–1) and Miso Cat 1 (scores 2–3). • TIQ (7 items, 0–21 range; Cronbach's α = 0.89); scored for tinnitus impact severity. • HIQ (8 items, 0–24 range; Cronbach's α = 0.93); scored for hyperacusis impact. • SAD-T (4 items, 0–12 range; Cronbach's α = 0.91); scored for anxiety and depression symptoms. • Mental health history questions: personal history of mental illness, contact with mental health professionals, parental mental illness during childhood (yes/no). |
| Procedures | • All questionnaires and audiological measures were completed at first clinic visit, prior to any treatment. • Questionnaires completed by patients independently in the waiting area. • Data anonymized prior to statistical analysis. • Welch's t-tests and chi-squared tests compared Miso Cat 0 vs. Miso Cat 1 on continuous and categorical variables, respectively. • One-way ANOVAs with Šídák post hoc tests compared ULLmin, PTA, HIQ, TIQ, and SAD-T across SSSQ4 score levels (0, 1, 2, 3). • Spearman correlations assessed relationships between SSSQ4 scores and all audiological and questionnaire variables. • Logistic regression modeled odds of SSSQ4 > 0; predictors included ULLmin-based hyperacusis, TIQ impact category, HIQ impact category, SAD-T category, ULL slope ≥20 dB, and HTL slope ≥20 dB; ORs reported unadjusted and adjusted for age and gender. |
| Results | • 23% of patients (Miso Cat 1) reported frequent misophonia symptoms; 42% reported any symptoms. • Miso Cat 1 patients were younger on average than Miso Cat 0; no significant difference by sex. • Audiometric thresholds (PTA) did not differ between Miso Cat 0 and Miso Cat 1, and PTA was not correlated with SSSQ4 scores. • Hearing loss category distributions did not significantly differ between Miso Cat 0 and Miso Cat 1. • Between-ear asymmetry in PTA or ULL did not differ between misophonia groups; no correlation with SSSQ4 scores. • Miso Cat 1 had significantly lower ULLmin than Miso Cat 0; ULLmin was moderately negatively correlated with SSSQ4 scores. • ULL slope was significantly greater (steeper) for Miso Cat 1 than Miso Cat 0 across both ears; moderately correlated with SSSQ4 scores. • HTL slope was significantly smaller (less steep) for Miso Cat 1 than Miso Cat 0; weakly negatively correlated with SSSQ4 scores. • TIQ, HIQ, and SAD-T scores were all significantly higher (worse) in Miso Cat 1 than Miso Cat 0; moderate to strong correlations with SSSQ4 scores. • History of mental illness, contact with mental health professionals, and parental mental illness in childhood were all more prevalent in Miso Cat 1. • In the adjusted logistic regression model, three predictors significantly increased odds of SSSQ4 > 0: severe tinnitus impact (TIQ ≥9), significant hyperacusis impact (HIQ >11), and presence of anxiety/depression (SAD-T ≥4). • HTL slope ≥20 dB significantly decreased the odds of SSSQ4 > 0 in the adjusted model. • ULLmin-based hyperacusis and ULL slope ≥20 dB were significant in unadjusted models but not in the adjusted model. |
| Discussion/Limits | Conclusion- • misophonia is prevalent among audiology clinic patients presenting with tinnitus and/or hyperacusis at a rate exceeding general population estimates. • misophonia is not restricted to individuals with normal hearing; a substantial proportion of both misophonia and non-misophonia groups had audiometric hearing loss. • a steeply sloping, high-frequency audiogram reduces the likelihood of frequent misophonia symptoms, likely because many trigger sounds are spectrally dominated by high frequencies whose audibility is reduced by such hearing loss. • absence of between-ear asymmetry effects suggests the mechanism underlying misophonia is central rather than peripheral in origin, consistent with neuroimaging evidence of altered non-auditory brain regions. • lower ULLmin values are associated with greater frequency of misophonia symptoms, pointing to generalized heightened sound sensitivity as a shared feature of misophonia and hyperacusis. • higher ULL slope in misophonia patients reflects disproportionate sensitivity to high-frequency sounds, consistent with known auditory perceptual unpleasantness associated with sounds in the 2.5–5.5 kHz range. • greater impact of tinnitus and hyperacusis, and presence of anxiety and depression, independently increase the odds of misophonia symptoms, consistent with shared neuropathology across these conditions involving auditory-limbic system alterations. • childhood parental mental illness is more prevalent among patients with frequent misophonia symptoms, suggesting adverse childhood experiences may be relevant to misophonia severity and treatment complexity. • clinicians assessing patients with tinnitus and hyperacusis should routinely screen for misophonia, particularly when ULLmin is abnormally low or TIQ, HIQ, or SAD-T scores are elevated, to guide selection of therapeutic strategies. |
| Limitations:: | • Misophonia assessed using only one questionnaire item (SSSQ4); no validated misophonia-specific questionnaire administered. • Validity and reliability of SSSQ4 as a misophonia measure have not been formally evaluated. • Retrospective design limited measures to those collected as part of routine care. • ULL measurement cap at 80 dB HL may have attenuated the observed between-group difference in ULLmin; true group differences are likely underestimated. • Sample restricted to audiology clinic patients with tinnitus and/or hyperacusis; findings not generalizable to the general population or mental health service populations. |
| Future Directions:: | • Use validated misophonia-specific questionnaires (e.g., MisoQuest, Amsterdam Misophonia Scale, Duke Misophonia Questionnaire) in future studies examining relationships with audiological variables. • Investigate history of various adverse childhood experiences (abuse, neglect, household dysfunction) in patients with misophonia. • Explore the directionality of the association between misophonia and psychiatric disorders; specifically, whether pre-existing misophonia increases risk of psychiatric comorbidity. • Examine psychoacoustic and electrophysiological characteristics of the auditory system in patients with misophonia to address gaps in understanding of auditory function in this population.• Use validated misophonia-specific questionnaires (e.g., MisoQuest, Amsterdam Misophonia Scale, Duke Misophonia Questionnaire) in future studies examining relationships with audiological variables. • Investigate history of various adverse childhood experiences (abuse, neglect, household dysfunction) in patients with misophonia. • Explore the directionality of the association between misophonia and psychiatric disorders; specifically, whether pre-existing misophonia increases risk of psychiatric comorbidity. • Examine psychoacoustic and electrophysiological characteristics of the auditory system in patients with misophonia to address gaps in understanding of auditory function in this population. |
| Relevance:: | • a good source for info looking at the relationship of misophonia with various hearing issues. • brings up interesting points about how specific sounds with certain energies are universally unpleasant, and this range composes a lot of triggers • they also bring up the idea that hearing changes could impact miso severity, i.e hearing loss in certain range would decrese perception of some triggers. but also loudness recruitment could exacerbate misophonia. • this could use a deeper review should we need an audiology approach to things. |
Notes
key terms and concepts
- misophonia – decreased tolerance for specific sounds (triggers), typically man- or animal-made, often orofacial in origin, eliciting anger or anxiety in the affected individual.
- hyperacusis – intolerance of certain everyday sounds perceived as too loud or uncomfortable, causing significant distress and functional impairment.
- tinnitus – perception of sound without an acoustical source external to the body.
- ULLmin – across-frequency average of uncomfortable loudness levels (ULLs) for the ear with lower average ULLs; values ≤77 dB HL indicate hyperacusis.
- ULL slope – absolute difference in ULLs between 8 kHz and 1 kHz for a given ear; reflects frequency-specific variation in loudness tolerance.
- HTL slope – absolute difference in hearing threshold levels (HTLs) between 8 kHz and 1 kHz; operationalizes steepness of audiometric configuration.
- SSSQ4 – item 4 of the Sound Sensitivity Symptoms Questionnaire; single-item screen asking how often over the past 14 days the patient felt angry or anxious when hearing specific trigger sounds.
- Miso Cat 1 – classification for patients reporting frequent misophonia symptoms (SSSQ4 score 2 or 3; bothered more than half of days in the prior 2 weeks).
- Miso Cat 0 – classification for patients reporting no or less frequent misophonia symptoms (SSSQ4 score 0 or 1).
- SAD-T – Screening for Anxiety and Depression in Tinnitus; 4-item questionnaire adapted from the PHQ-4; scores ≥4 indicate clinically significant anxiety/depression symptoms.
- TIQ – Tinnitus Impact Questionnaire; 7-item scale; scores ≥9 indicate severe tinnitus impact.
- HIQ – Hyperacusis Impact Questionnaire; 8-item scale; scores >11 indicate clinically significant hyperacusis impact.
my engagement notes
my questions
- How are false positives measured? (page 10)
my comments
- I agree that it would be limited to just those with normal hearing, but the fact that this samples was drawn from a clinic for people were specifically going for hearing concerns makes me think there was probably selection bias that influenced this outcome (page 8)
Bookmarks
reading notes
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Misophonics found sounds in the higher frequency range to be more bothering then lower frequency. this is in line with tendency of people to fined sounds with energies in 2.5-5.5 kHz range unpleasant. (page 11)
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Major weakness. Very likely misrepresented the number of misophonics. Though if i had to guess, i would assume that the bias would’ve been an under reporting , given how much more complicated to identify a single question can find (page 12)
Zettelkasten
Misophonia Prevalence estimates are variable by study population
underrepresentation of audiological perspectives in Misophonia
Idea that hearing changes could have impact on Misophonia
uncomfortable loudness level (ULL)-
possible overlap in acoustics of generally aversive sounds and Misophonic triggers