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  • Dr. Rohe | Tinnitus and Hearing Center of Arizona Misophonia
    10 months ago

    Part 3

    Edelstein, who was not involved in this study, comments “There was a huge gap in the literature until recently. I think this study was a triumphant effort towards gleaning neurophysiological insights on misophonia and its findings fit nicely into the narrative emerging from behavioral research on misophonia.”

    It has also been proposed that altered brain connectivity underlying misophonia may be similar to that occurring in synesthesia, a condition in which one sensory stimulus evokes sensation in a different modality (e.g., the letter “A” is associated with the color red). Faulty enhanced neural connections could theoretically lead to abnormal associations amongst sensory and emotional brain regions in misophonia, although this hypothesis remains untested.

    Pacifying sound distress

    Given the novelty of misophonia, effective therapies have been inadequately assessed. However, there is some support for the use of cognitive behavioral therapy and conditioning retraining. Hopefully, with further research into both its psychological profile and neurobiological underpinnings, misophonia will gain both greater social acceptance and effective treatment options.

    PLOS “The Brain Basis Of “Hatred of Sound”: Misophonia.” NeuroscienceNews. NeuroscienceNews, 24 September 2017

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona Misophonia
    10 months ago

    Part 2

    The misophonic brain

    Despite an advancing understanding of the psychological and behavioral manifestations of misophonia, little research has attempted to clarify its neurobiological bases. Researchers suspect that misophonia is not a primary auditory disorder, but rather stems from aberrant attentional or emotional processing later in the brain’s auditory system. There is preliminary support for this explanation from one small EEG study. In an oddball auditory paradigm, misophonic participants showed a smaller N1 evoked potential than controls elicited by unexpected auditory tones, whereas the “pre-attentive” P1 component showed no group difference. The N1 is involved in early attention and detecting sensory changes, suggesting that abnormal attentional signaling early in the auditory processing stream may contribute to misophonia. Interestingly, an altered N1 peak has also been associated with impulsivity, drug abuse and bipolar disorder.

    Recently, researchers used fMRI to examine brain activity in misophonic individuals while they listened to sounds that were neutral, unpleasant or characteristic misophonia triggers. The misophonics rated the trigger sounds as more distressing than the unpleasant or neutral sounds, whereas normal controls rated trigger and unpleasant sounds as similarly annoying, confirming a selective intolerance for triggers by misophonics.

    Critically, the misophonics showed greater activation in the insula than controls during trigger sounds, and this activity increased with greater reported distress. Furthermore, functional connectivity between the insula and other brain regions involved in attention and emotion was altered in misophonics when listening to trigger sounds. Although the insula has been promiscuously implicated in a plethora of cognitive processes, its proposed functions include internal awareness of one’s body and emotional states. Though preliminary, these findings suggest that misophonia is associated with pathological activation of a brain network supporting interception.

    PLOS “The Brain Basis Of “Hatred of Sound”: Misophonia.” NeuroscienceNews. NeuroscienceNews, 24 September 2017

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona Misophonia
    10 months ago

    Part 1

    Characterizing the “hatred of sound”

    Since “misophonia” was first coined in the early 2000’s, efforts have been made to characterize its symptoms through patient interview. Although its prevalence remains uncertain due to its still relative obscurity, studies suggest that it typically strikes in adolescence, affects men and women equally, and may occur in much as 20% of the population. The most commonly reported trigger sounds include eating, breathing or repetitive behaviors like typing or pen clicking. Hearing such sounds often evokes uncontrollable irritation, disgust or anger, which the individual recognizes as socially inappropriate. Therefore, the misophonic may try to suppress any outward reaction, with few acting upon their urges with verbal or physical aggression. These aversive responses in fact manifest as measurable physiological arousal. Compared to healthy controls, misophonic individuals have excessive skin conductance responses to auditory stimuli, and the magnitude of these skin responses correlates with how distressing the participants perceive the sounds.

    An undiagnosed disorder?

    The symptoms of misophonia largely overlap with other clinically accepted psychiatric disorders, including obsessive compulsive disorder (OCD), post-traumatic stress disorder, and various phobias. Some individuals reporting misophonic symptoms also have comorbid psychiatric conditions such as attention-deficit hyperactivity disorder, hypochondria, OCD, or eating disorders. Although some experts advise that misophonia be identified as a unique psychiatric disorder, it has yet to be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

    Miren Edelstein, a graduate student at the University of California San Diego who researches misophonia, explains that “The uncertainty surrounding the official status of misophonia as a discrete disorder stems from the fact that it does indeed have some similarities with other existing conditions. However, while some misophonics definitely do suffer from some of these other existing conditions, many do not and report no other ailments whatsoever. Because of this variation, I don’t believe another existing disorder can completely account for the specific constellation of symptoms present in misophonia.”

    PLOS “The Brain Basis Of “Hatred of Sound”: Misophonia.” NeuroscienceNews. NeuroscienceNews, 24 September 2017

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona posted a new discussion

    3 years ago

Misophonia is sometimes called soft sound sensitivity syndrome or 4S. The term misophonia now seems to be preferred among professionals. It is considered to be one particular form of decreased sound tolerance or DST. Misophonia is characterized by a very strong negative reaction to particular body or environmental sounds, called “triggers” usually but not always associated with those sounds being produced by particular people and in certain situations. Triggers can also be visual or associated with certain environmental settings, thoughts, or other sensory contacts like smell or touch. Triggers often can have an “anticipatory” stage which occurs before a trigger sound is experienced.

Misophonia represents an abnormally strong negative reaction of the autonomic and limbic systems of the brain to specific sounds resulting in enhanced functional connections between the auditory and limbic system for these sounds. Misophonia refers behaviorally to a fight or flight reaction to specific meaningful sounds or events associated with those sounds. Misophonia is considered an auditory symptom, but is not related to the peripheral (inner ear) auditory mechanism. It is not fear or hatred of all sound.

Researchers agree that misophonia appears to involve the development of conditioned response mechanisms that are fairly complex, involving the auditory system, the brains’ limbic system centers, the autonomic nervous system, the parasympathetic nervous system, and cortical short term, long term and working memory centers. Misophonia occurs due to the creation of a conditioned reflex arc (a sequence of circuits activating), yielding an immediate autonomic (unconscious) reaction, further enhanced by a feedback loop, which creates the “vicious circle scenario”, reinforcing the reactions to continue reoccurring and neurologically strengthen via frequent repetition. An analogy of conditioning would be the effects on mind and body as athletes “train” over time to develop their sport’s skills much more effectively, except that for the athlete the training conditioning is conscious, whereas for misophonia it is largely unconscious. Misophonia then is not a single process and mechanism, but a complex group of systems and one that suggests it is a single damaged “spot” or single mechanism.

Misophonia is a term first used by neuroscientist Dr. Pawel Jastreboff in 2002 as part of his updated published research on Tinnitus Retraining Therapy (TRT). Previously misophonia had not been identified as a distinct “condition” in medical, audiological or psychological literature. If misophonia was treated, it would be as secondary “symptoms” to other medical, behavioral and/or psychological conditions. Even today, misophonia is not considered as a generally known or recognized medical or psychological diagnostic condition. This is one reason why so many physician’s and insurers are unfamiliar with the term “misophonia”. Dr. Jastreboff further updated the classification of misophonia in 2012 as one of the distinct forms of intolerance under the broader category of Decreased Sound Tolerance or DST, which currently would best be associated with the broad medical diagnostic categories (ICD-9 code) of abnormal auditory perception and/or hyperacusis. To date, there still is not a distinct classification of any form of decreased sound tolerance in the psychological classification system, called DSM-5.

Misophonia was first treated after 1990 during the first use of Tinnitus Retraining Therapy procedures for severe tinnitus disturbance by Dr. Jastreboff in the United States and Dr. Jonathan Hazell in Great Britain. Dr. Jastreboff observed that nearly 60% of individuals under treatment using TRT demonstrated significant sound intolerance. Soon afterwards he identified hyperacusis and phonophobia as being involved in and having distinct mechanisms in these cases. At that time a new category called misophonia was first mentioned, describing certain reactions which were not exactly explained by either hyperacusis or phonophobia alone.

Most typically misophonia occurs in childhood, often during early adolescence, but can also occur in adulthood. It typically begins with a sudden onset after some emotionally significant precipitating event associated with a first “trigger” sound and environmental situation associated with a strong emotional event. Misophonia as a secondary symptom accompanying tinnitus or hyperacusis can occur at any age, usually associated with a condition of auditory damage or head trauma. Misophonia symptoms can also occur secondary to multi-sensory sensitivity problems demonstrated in early childhood in more complex neurological conditions such as Autism Spectrum Disorder.

Abnormal sound sensitivities in classic primary misophonia are most frequently to “mouth” noises such as eating, chewing, breathing, lip smacking, licking, whistling or the sound of certain speech sounds. Body sounds are called “somatosounds” by Dr. Jastreboff. Most commonly, reactions begin in response to particular individuals only, typically parents or siblings. Sometimes non-speech sounds are also problematic, such as pen clicking, rustling paper, keyboard clicks, etc. In many cases non-auditory visual or other sensory inputs or contextual settings act as triggers, such as particular rooms or objects in rooms. Many patients report being in an apprehensive state even before encountering a sound trigger. This appears to be part of a hypervigilence or monitoring attention process, activating the limbic system in the brain. Some individuals with multi-sensory hypersensitivities also have reactions to light, odors, the feel of objects, and the sight of certain objects.

Decreased sound tolerance must be considered in the context of overall health status and may be a symptom of a variety of disorders. It is also important to understand that everyone has some degree of misophonia to certain sounds. A classic example is our reaction to the screeching sound created by or the thought of fingernails scraping along a blackboard. Patients with clinically significant misophonia may show psychological, neurological or developmental conditions that may be primary to misophonia, or secondary to it. This list includes:

• Multi-sensory hypersensitivity

• Hyperacusis

• Tinnitus

• Hearing loss

• Phonophobia

• Tonic tensor tympani Syndrome (TTTS)

• Acoustic shock

• Family relational problems

• Intermittent explosive disorder (IED)

• Major depressive disorder

• Anxiety disorders, including social anxiety disorder, generalized anxiety disorder, post-traumatic stress syndrome (PTSD), and agoraphobia

• Obsessive compulsive disorder (OCD)

• Autism spectrum disorder or Aspberger’s syndrome

• Traumatic brain injury (TBI)

• Bell’s palsy

• Ramsey-Hunt syndrome

• Superior canal dehiscence syndrome

• Stapedectomy

• Perilymph fistula

• Hearing loss

• Tinnitus

• Migraine

• Head injury

• Lyme disease

• Williams syndrome

• Lacunar stroke

• Epilepsy

• Autism

• Narcotic and benzodiazepine withdrawal

Misophonia Management

A multi-disciplinary treatment approach appears to be the best treatment, and in most cases is essential for progress. This must be preceded by a thorough evaluation and receiving sufficient counseling for the patient and family members to understand the condition and how it may be treated.

Clinically significant misophonia almost always involves changes in behaviors not only from the suffering patient but also within the whole family, as the whole family attempts to cope with the reactions that are occurring. As most triggers are experienced during family interactions, the condition of misophonia is properly viewed as a true family affair. Therefore, having mental health or behavioral professionals involved in misophonia treatment who specialize in family as well as individual therapy can be very beneficial. These professionals are trained and qualified to identify key behavioral and family relationship difficulties that may be relevant to the misophonia problem, before, during or as a result of reactions to triggers. Qualifications of a licensed psychotherapist or behavioral scientist for misophonia may include strong skills in Cognitive Behavioral Therapy, Dialectical Behavioral Therapy and possibly Mindfulness Therapy, and a strong background working with family therapy, pain management, depression and anxiety.

Wednesday, 29 April 2015
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Dr. Rohe | Tinnitus and Hearing Center of Arizona


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