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Year 2025

Abstract Misophonia is a condition of intolerance to certain sounds which act as triggers. This study investigates auditory processing abilities using behavioral measures in normal-hearing individuals with and without misophonia. Thirty participants aged between 18 and 30 years were included. They were divided into two primary groups: 15 individuals diagnosed with misophonia and 15 controls. All of the participants underwent auditory processing tests such as masking level difference (MLD), dichotic consonant-vowel (DCV), and pitch pattern tests (PPT). From the analyzed data, individuals with misophonia showed significantly reduced scores in DCV and PPT. Also, there was no significant difference in the thresholds of MLD at 500 Hz. This study highlights that the reduced scores of DCV and PPT in individuals with misophonia could be attributed to poor auditory cortical processing compared to the control group.

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Aliases

Auditory Processing and Neuroregulation in Misophonia
(Karupaiah & Prabhu, 2025)

Key Terms

Misophonia
central auditory processing (CAP)
Masking level difference (MLD)
Dichotic Consonant-Vowel (DCV) test
pitch pattern test (PPT)
RAMISO-S
Duke-Vanderbilt Misophonia screening questionnaire

Import Date 10-05-2025

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Dv Authors Kamalakannan Karupaiah, Prashanth Prabhu,

Dv Limitations • Small sample size • Use of only behavioral (not electrophysiological) measures limits inferences about neural mechanisms.

Dv Future Directions • Incorporate electrophysiological measures (e.g., ABR, cortical evoked potentials) to map precise neural correlates. • Explore auditory processing variations across a broader range of misophonia severity levels. • Develop tailored interventions targeting cortical auditory deficits in severe misophonia.

Dv Relevance • looks at the auditory processing of Misophonics vs controls to test speculative in Misophonic cortical/brainstem processing abnormalities. found evidence for altered cortical auditory processing (but unaltered brain stem processing) for those with mild-severe Misophonia (contradicts the Jastreboff model assumption of normal auditory processing ) • a decent source for the audiologist approach to methods and conceptualization of Misophonia

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Auditory Processing and Neuroregulation in Misophonia: A Comparative Study of Behavioral Measures

Status:: #status/reviewed

Metadata

Item Type: #journalArticle
Authors:: Kamalakannan Karupaiah, Prashanth Prabhu,
Date:
Date Added: 1759424209000
URL: https://www.neuroregulation.org/article/view/23526/version/1178
DOI: 10.15540/nr.12.3.172
Cite Key: karupaiahAuditoryProcessingNeuroregulation2025
Topics: [object Object]
Tags:: #audiology, #auditory-processing-abilities, #Bare-bones-review-🦴, #binural-integration, #clinical, #masking-level-difference, #Misophonia, #Neurology,
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Abstract


Background/Purpose	Background- • Misophonia is linked with abnormal neural responses to specific trigger sounds, leading to atypical emotional and attentional reactions. • Past research yielded inconsistent results regarding auditory processing differences in individuals with misophonia. • Recent studies suggest cortical involvement in misophonia through fMRI and auditory evoked potential data • Prior behavioral studies either lacked severity stratification or did not focus on higher-severity misophonia. Purpose- • To assess auditory processing (binaural interaction, binaural integration, and temporal processing) in normal-hearing individuals with moderate-to-severe misophonia using behavioral auditory tests (MLD, DCV, PPT). • To determine whether auditory processing abnormalities in misophonia are cortical or brainstem-based.
Participants/samples	• Total participants: 30 (18–30 years, Mean = 24.23, SD = 2.91) • Misophonia group: 15 (10 moderate, 5 severe) • Control group: 15 • Gender: 23 female, 7 male • Inclusion Criteria: Normal hearing, no history of otological disorders, no tinnitus, hyperacusis, or phonophobia. • Exclusion Instruments: THI, MKHQ, DSTS-S.
Measures	• Self-report screening: Duke-Vanderbilt Misophonia Screening Questionnaire, RAMISO-S • Hearing tests: Pure tone audiometry, tympanometry, DPOAEs • Auditory Processing Tests: • DCV Test: Right, left, and double correct syllables • PPT: Correct identification of tone sequences • MLD: Detection threshold difference between SoNo and SπNo conditions
Procedures	• Stimuli: • DCV: Six syllables (/pa/, /ba/, /ta/, /da/, /ka/, /ga/) delivered binaurally with 0ms lag. • PPT: Sequences of three tones (500ms each) using 880 Hz and 1430 Hz frequencies. • MLD: 500 Hz tone in noise presented in homophasic and antiphasic configurations. • Instructions: • DCV: Repeat both heard syllables • PPT: Identify high/low tone sequence • MLD: Signal detection amid background noise • Calibration and Environment: ANSI standard acoustic chamber with calibrated equipment.
Results	• found altered cortical processing but no alterations in brainstem processing (consistent with Aryal and Prabhu, 2023) (page 7) • DCV: Misophonia group showed significantly reduced right, left, and double correct scores (all p < .05). • PPT: Significantly reduced scores in misophonia group (p < .05). • MLD: No significant difference in MLD thresholds at 500 Hz between groups (p > .05).
Discussion/Limits	Conclusion- • Behavioral evidence suggests altered cortical auditory processing (binaural integration, temporal processing) in individuals with moderate-to-severe misophonia. • Brainstem-level auditory processing (as indexed by MLD) appears preserved. • Findings align with neuroimaging evidence indicating disrupted connectivity between auditory and emotional brain areas.
Limitations::	• Small sample size • Use of only behavioral (not electrophysiological) measures limits inferences about neural mechanisms.
Future Directions::	• Incorporate electrophysiological measures (e.g., ABR, cortical evoked potentials) to map precise neural correlates. • Explore auditory processing variations across a broader range of misophonia severity levels. • Develop tailored interventions targeting cortical auditory deficits in severe misophonia.
Relevance::	• looks at the auditory processing of Misophonics vs controls to test speculative in Misophonic cortical/brainstem processing abnormalities. found evidence for altered cortical auditory processing (but unaltered brain stem processing) for those with mild-severe Misophonia (contradicts the Jastreboff model assumption of normal auditory processing ) • a decent source for the audiologist approach to methods and conceptualization of Misophonia

Notes

key terms and concepts

Central Auditory Processing (CAP) – The efficiency and effectiveness by which the central nervous system uses auditory information, including skills like binaural integration, interaction, and temporal processing. (page 2)
Misophonia – A disorder marked by a strong aversion to specific sounds (e.g., chewing, breathing), eliciting emotional, physiological, and behavioral responses disproportionate to the acoustic properties of the stimuli.
Masking Level Difference (MLD) – A behavioral test of binaural interaction typically at the brainstem level; evaluates the auditory system’s ability to detect tones in noise.
Dichotic Consonant-Vowel (DCV) Test – A measure of binaural integration at the cortical level requiring the processing of different syllables presented simultaneously to both ears.
Pitch Pattern Test (PPT) – A test assessing temporal ordering (sequence recognition of high vs. low tones) at the cortical level.
RAMISO-S – Revised Amsterdam Misophonia Scale – Severity; used to assess severity levels of misophonia.
Duke-Vanderbilt Misophonia Screening Questionnaire – A validated tool for screening misophonia symptoms and functional impact.

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Clinical Implications:

Suggests including behavioral auditory processing tests in misophonia assessment protocols.
Interventions may benefit from addressing attention and cortical auditory processing mechanisms.

Methodological Insight:

Clear differentiation between cortical (DCV, PPT) vs. brainstem (MLD) levels in auditory processing allows localization of functional deficits.