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Id 8a3c76c4-67d9-42dd-8c0e-684095565acc
Year 2019
Abstract Introduction: Misophonia is characterized by the aversion to very selective sounds, which evoke a strong emotional reaction. It has been inferred that misophonia, as well as tinnitus, is associated with hyperconnectivity between auditory and limbic systems. Individuals with bothersome tinnitus may have selective attention impairment, but it has not been demonstrated in case of misophonia yet.
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- purpleRed
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- (Silva & Sanchez, 2019)
Import Date 04-03-2026
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Evaluation of selective attention in patients with misophonia
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Metadata
- Item Type: #journalArticle
- Authors:: Fúlvia Eduarda da Silva, Tanit Ganz Sanchez,
- Date:
- Date Added: 1625501381000
- URL: https://linkinghub.elsevier.com/retrieve/pii/S1808869418300685
- DOI: 10.1016/j.bjorl.2018.02.005
- Cite Key: silvaEvaluationSelectiveAttention2019
- Topics: [object Object]
- Tags:: #Misophonia, #Bare-bones-review-🦴, #Attention, #selective-attention,
- PDF Attachments
Abstract
| Background/Purpose | Background- • Misophonia is characterized by aversion to selective, typically low-level, repetitive sounds that provoke disproportionate emotional reactions. • Misophonia and tinnitus have been proposed to share general similarities, including hyperconnectivity between auditory and limbic systems. • Both conditions are associated with difficulty disengaging attention from offending sounds, contributing to quality of life impairment. • Selective attention impairment has been demonstrated in individuals with bothersome tinnitus but has not been investigated in misophonia. Purpose- • Overall goal: evaluate selective auditory attention in individuals with misophonia relative to two control groups (tinnitus without misophonia; asymptomatic). • Experiment-specific goal: determine whether selective attention impairment in misophonia is specific to trigger-congruent sounds (chewing) versus non-specific distractors (white noise). |
| Participants/samples | • Total N = 40 normal-hearing participants across three groups. • Misophonia Group (MG): n = 10; 6 female, 4 male; mean age 31.6 years; range 14–48. • Tinnitus Control Group (TCG): n = 10; 6 female, 4 male; mean age 42.2 years; range 29–59. • Asymptomatic Control Group (ACG): n = 20; 12 female, 8 male; mean age 31.7 years; range 25–45. • Inclusion (all groups): bilateral hearing thresholds ≤25 dBHL at 250–8000 Hz; age >12; fluent reading ability. • MG inclusion: clinical history of misophonia with VAS annoyance score ≥6. • TCG inclusion: no misophonia history; continuous tinnitus with VAS annoyance score ≥6. • ACG inclusion: no misophonia and no tinnitus history. • Three TCG participants excluded for abnormal hearing thresholds; replaced from waitlist. • Groups were recruited via social media (Facebook) and mailing lists from a reference center for tinnitus/misophonia. • TCG had significantly higher mean age than ACG; no significant age difference between MG and TCG or MG and ACG. |
| Measures | • Brazilian Portuguese version of the Dichotic Sentence Identification (DSI) test. • VAS (0–10) for annoyance severity (used for group eligibility screening). • Pure-tone audiometry (Madson Astera II audiometer; Sennheiser HAD 200 headphones) for hearing threshold screening. • Otoscopic inspection (Welch Allyn model 19090) for external auditory canal and tympanic membrane. |
| Procedures | • DSI test administered in three situations per participant: (1) conventional DSI alone, (2) DSI + white noise distractor, (3) DSI + chewing sound distractor. • DSI Stages 1–5 used (Stage 6 excluded as it is therapy-targeted); Stage 1 = calibration, Stage 2 = training, Stage 3 = binaural integration, Stages 4–5 = directed report (right and left ear). • Test presented at 50 dBNA; signal-to-noise ratio for distractors set at 15 dBNA. • Distracting sounds (white noise; chewing) edited, treated, and looped by a specialized professional using Audacity Software. • Order of distractor presentation randomized 1:1 across participants. • Visual support provided; participants indicated identified sentences using printed sentence list. • Statistical analysis: ANOVA with repeated measurements and three fixed factors (group, stage, situation); Games-Howell method for pairwise age comparisons. |
| Results | • MG showed lower correct responses than both TCG and ACG on the DSI + chewing condition; differences were present for both pairwise comparisons. • No group differences in correct responses on conventional DSI alone or DSI + white noise. • Directed report stage yielded higher correct responses than binaural integration stage across all groups and situations (all ears). • Right ear correct responses were greater than left ear responses in binaural integration across all groups and situations. • No interaction between stage and other factors; interaction between group and situation was present. • TCG and ACG correct response rates remained stable across all three DSI situations. • One MG participant showed markedly discrepant performance on DSI + chewing in the binaural integration (left ear) and directed report (left ear) stages; this participant had maximum VAS score and reported self-generated sounds as triggers. • MG showed very low minimum values on DSI + white noise (directed report, right ear) and DSI + chewing (binaural integration, left ear; directed report, left ear). |
| Discussion/Limits | Conclusion- • selective attention impairment in misophonia is specific to sounds that trigger the condition, not to auditory distraction in general. • The findings indicate that misophonic individuals' selective attention is not disrupted by white noise, suggesting the effect is not attributable to general distraction. • The TCG and ACG results suggest that exposure to external distracting sounds, whether tinnitus-like or not, does not provoke selective attention impairment in non-misophonic individuals. • The data support the clinical observation that misophonic patients report attention specifically disrupted by particular annoying sounds rather than sounds in general. • The findings indicate that right-ear superiority on dichotic listening tasks across all groups reflects functional hemispheric asymmetry mediated by brainstem efferent regulation and dominant hemisphere interference with non-dominant hemisphere processing. • difficulties in binaural integration relative to directed report, consistent across all groups, may reflect demands on attention and/or working memory. • The findings indicate that the TCG results do not align with clinical reports of tinnitus patients experiencing performance decrements when hearing their own tinnitus or tinnitus-similar sounds, a discrepancy the authors note but do not fully resolve. • the age difference between TCG and other groups is unlikely to be clinically relevant given that TCG mean and median ages were below 45 years with no elderly participants. |
| Limitations:: | • Small sample sizes, particularly for TCG (n = 10), may have been underpowered to detect selective attention effects in that group. • Computer-generated trigger sounds produced lower ecological impact than real-life human-generated sounds, as reported spontaneously by MG participants; this may have attenuated the magnitude of observed effects. • Groups were not fully matched on age; TCG was significantly older than ACG. |
| Future Directions:: | • Larger samples, particularly for the tinnitus group with normal hearing, are needed. • Functional neuroimaging (e.g., brain activation mapping before, during, and after trigger sound exposure) recommended to further characterize selective attention mechanisms in misophonia. • Development of specific intervention strategies to reduce discomfort in misophonic individuals is indicated. |
| Relevance:: | • used dichotic listening task to look at selective attention across Misophonics, those with tinnitus, and controls. they found a difference in average correct resposnes between the groups, with the Misophonia group scoring lowest. • a good source for a audiometric approach to looking at selective attention in Misophon |
Notes
key terms and concepts
- misophonia – condition characterized by aversion to very selective sounds, usually of low level and repetitive, that provoke a strong, abrupt, and disproportionate emotional reaction.
- dichotic sentence identification (DSI) test – auditory test evaluating selective attention via figure-background discrimination for verbal sounds; involves simultaneous presentation of two sentences to each ear across stages of binaural integration and directed report.
- selective attention – auditory capacity to identify speech sounds in the presence of competing sounds; assessed here via dichotic listening.
- binaural integration – DSI stage in which the individual identifies both sentences presented simultaneously to each ear.
- directed report – DSI stage in which the individual attends to and reports only the sentence presented to a specified ear.
- hyperconnectivity – proposed excessive functional connectivity between the auditory and limbic systems, hypothesized to underlie both misophonia and tinnitus.
- Visual Analogue Scale (VAS) – 0–10 self-report scale used to quantify annoyance severity for misophonia or tinnitus inclusion criteria.
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contextual statement
In a 2018 study, Silva attempted to evaluate selective auditory attention in individuals with misophonia compared to tinnitus and asymptomatic controls by administering the Brazilian Portuguese Dichotic Sentence Identification (DSI) test under three conditions: conventional, with white noise, and with a chewing sound distractor.
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audiological evidence of trigger specific impairments to selective attention in Misophonia