Overview

Misophonia and hyperacusis are two similar but distinct conditions that affect your hearing experiences. Misophonia is characterised by an aversion to certain sounds that induce a variety of negative emotions. Hyperacusis, on the other hand, is an increased sensitivity to certain sounds, making them seem louder to you than to other people. While associated with hearing, the root of these issues does not lie within the ear, but rather has neurological origins. Due to this, strategies to help treat these conditions are therapy-based and work to change your perception of the “trigger sounds” that can impact the quality of your life.

Differences through definitions

Misophonia is defined as a condition described as a strong emotional response to certain sounds, which can be found in everyday life. Common examples of this are the sound of loud eating or of sharp scratching, which is specific but something that can be found fairly commonly.¹ These trigger sounds can be present at any volume.

Hyperacusis, on the other hand, is increased sensitivity to certain noises, regardless of volume. These trigger sounds may not be specific but rather can be categorised, such as vehicle horns, footsteps, or speech. If you have hyperacusis, you perceive these sounds to be louder than how others experience them, with these sounds not necessarily being “harsh” or “grating” like scratching or screeching.

There is no complete list of trigger sounds for misophonia, but noted particular sources include bass noises through walls, cutlery clinking and whistling. While these are specific examples, it is common for similar noises to be triggers too, such as any low-frequencies (such as at concerts, lawn-mowers or other electric gardening equipment) or high-pitched noises (such as screaming, tire screeching or those that come from animals).

People can have misophonia and hyperacusis together, feeling both the strong emotions from the triggers as well as a higher sensitivity to them. Both conditions are related to sound, but additionally, triggers can extend to affect sight, smell, taste and touch.

Responses to triggers

As described above, misophonia is associated with strong emotional responses, which are typically, but not always, associated with involuntary, negative reactions. Examples of these responses are tensed muscles, sweating and increased heart rate. The intensity of these varies depending on the person as well as the duration, which can range from less than a minute to more than an hour.²

As hyperacusis is a sensory condition, triggers are experienced as being louder than usual. Due to this, reactions tend to be of general discomfort and not exclusively emotional (even though they can be). Like misophonia, reactions are dependent on the person, and it is common to want to cover your ears when presented with the trigger due to its perceived volume.

Associated conditions

As misophonia is characterised by an emotional response, associated conditions include obsessive compulsive disorder (OCD) and anxiety. The latter of these may emerge when dreading an oncoming trigger.^3,4

Hyperacusis is associated with other sensory issues such as tinnitus, buzzing or ringing in the ears when there is no external sound present, and hearing loss. The presence of triggers can also cause migraines and, in extreme cases, loss of coordination.³

Tinnitus retraining therapy

Tinnitus retraining therapy (TRT), as the name suggests, is a type of treatment used to target tinnitus, but is also an option for misophonia and hyperacusis. TRT consists of two components, counselling and sound therapy.

Counselling starts with a consultation period, whereby a doctor or other healthcare professional, typically an audiologist, carries out an assessment of your hearing ability and will try to understand how your triggers affect you specifically. You may also be offered support to help alleviate the stress or depression that can be associated with encountering your triggers.

Sound therapy consists of white noise being played to you to mask your tinnitus, in an attempt to alter neuronal connections that influence your perception of sound.⁵ Due to specialised equipment that is required for these practices, sound therapy is not typically offered via the NHS, so you will need to consult private healthcare for this.

In the context of misophonia, the purpose of TRT is to change attitudes and thought patterns towards triggers so that they do not bother you, or at the very least do not lead to strong emotional responses. For hyperacusis, TRT serves to increase your tolerance to your triggers to hopefully bring them down to the perceived volume of other noises.

Sound therapy

While TRT has a component of sound therapy, this is usually in a clinical setting, in the presence of professional supervision. Sound therapy, however, can be utilised in different ways at your own pace to increase the quality of life.

Ambience, such as in the form of whale songs or low-volume white noise, may be played while asleep, the former due to its calming effects. White noise is used due to its consistent and constant texture, which is thought to stimulate certain areas of the brain to activate the secretion of dopamine.⁶

These ambient noises are also popular to help relax or focus when awake, typically on a certain task, but can also help move your mind away from unwanted stimuli, such as your triggers. Implementing soothing sounds by yourself does not technically constitute “sound therapy”, but has similar principles of incorporating sonic exposure to “rewire” your auditory perception.^7,8

Hearing aids

While the most widely used form of treatment regarding auditory issues, hearing aids may not be the most ideal treatment strategy for hyperacusis. In fact, they should be avoided if you suffer from hyperacusis. This is because the condition is characterised by an increased sensitivity to certain noises; hearing aids function to amplify noises indiscriminately, thus worsening your experience of trigger noises. If you have misophonia, hearing aids would not benefit you either, as they would merely amplify the triggers that you wish to avoid.

If you believe that you have one of these two conditions but already use hearing aids, you should consult a healthcare professional about how you should proceed. It is not advised to stop using hearing aids completely before this, as you may find that this causes more hindrance than help.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a type of psychotherapy that is used for a variety of mental conditions such as depression, anxiety and behavioural disorders. CBT can be used to target misophonia, particularly the emotional responses to unpleasant stimuli, but also the thought processes which they stem from.

CBT is built upon the basis of three core aspects: thoughts, feelings and behaviour. Working with a psychotherapist, all these areas can be targeted to reshape your mindset regarding triggers and how you feel about them. A large part of this therapy is learning to accept that triggers are things that you cannot change and should therefore be accepted.⁹

Exposure therapy is the practice of presenting someone with the object or concept that they have issues with, in hopes of them growing more accustomed to it and allowing negative thoughts and associations to lessen eventually. An example of this would be presenting spiders to someone who has arachnophobia. In the context of misophonia, it is aimed to disconnect yourself from the negative associations you have with your triggers.¹⁰ Exposure therapy also exists as a treatment option outside of CBT, which is where it would benefit those with hyperacusis more, since this would be more about building a loudness tolerance to triggers.

CBT may be used with other interventions, such as those suggested above (apart from TRT, since multiple therapies are rarely carried out simultaneously.

Summary

Misophonia and hyperacusis are two auditory conditions that affect people differently to each other. Even though their characteristics are not the same, there is overlap with different treatment options – exposure therapy, CBT, and sound therapy provide different benefits for each condition. Treatments should also address the additional conditions that are associated with misophonia and hyperacusis, such as anxiety, OCD, or higher sensitivity of other senses. Ultimately, the most important aspect regarding misophonia and hyperacusis is that the symptoms that sufferers have are entirely subjective, in terms of extent and by which triggers bring them about. This reflects the need for specialised, tailored plans to alleviate any discomfort and maximise quality of life.