Misophonia and Hyperacusis


Hyperacusis is an abnormal sensitivity to everyday sound levels or noises. Often sensitivity is more pronounced at higher-pitched sounds. Many of these patients have essentially normal hearing. Currently, hyperacusis has been associated with certain types of head injuries, i.e., closed head injury (even mild in nature). Noise-induced trauma, ingestion of therapeutic drugs, toxic reaction to poison/venom, post-traumatic stress disorder, auto accidents with whiplash or neck injury, sudden onset of tinnitus, extended use of earplugs, meningitis, Lyme Disease, vestibular disorders, and Menier’s disease are all strong factors for creating hyperacusis. The Type IV category of tinnitus based on Jastreboff Neurophysiologic of tinnitus is characterized by the presence of reactive tinnitus and hyperacusis, which creates significant challenges to the daily activities of the patient. Dr, Marghzar has extensive experience in treating these cases since 1997.


Misophonia is a condition in which certain sounds (regardless of their loudness)  trigger emotional or physiological reactions that some might perceive as unreasonable given the circumstance. The specific sounds are called “triggers” and can be any sound. However, most patients complain about chewing sounds, sniffing, swallowing, slurping, or even typing sounds. Misophonia is more prevalent in teenagers and can linger for years. Those who have Misophonia might describe it as when a sound “drives you crazy” or “making me mad”.  The reaction of the patient can range from anger and annoyance to panic and the need to flee. In some cases, Misophonia can co-exist with hyperacusis. This can be determined during the evaluation and the in-person interview.  Reactions to the sound depending on the patients’ past history and on non-auditory factors like the patient’s previous evaluation of the sound, her / his psychological profile, and the context in which the sound is presented. Misophonia can be treated successfully especially if It is associated with hyperacusis.


Phonophobia is a fear of loud sounds due to its potentially damaging effects. It is generally associated with migraines, but many tinnitus patients, without migraines, do have phonophobia. Most patients with hyperacusis have certain degrees of phonophobia or misophonia or both.

Tinnitus Retraining Therapy (TRT)  for Hyperacusis

Tinnitus Retraining Therapy (TRT) for Hyperacusis is an effective treatment approach for many individuals with hyperacusis, even in some of the most severe cases. TRT is a treatment initially designed for tinnitus, but subsequently was found to be successful for hyperacusis treatment as well. Many patients with hyperacusis strongly believe that their condition results directly from damage to the inner ear. However, crucial in this review is acceptance of the concept that hyperacusis is primarily a disorder of central auditory processing. Dr. Marghzar’s doctoral dissertation focused on hyperacusis and its possible physiologic reason. His findings strongly suggested that a pathway from the brain to the ear has something to do with hyperacusis.

Directive counseling for people affected by hyperacusis is typically very intense. The counseling involves a detailed individualized explanation of the mechanisms involved with hyperacusis and the role these mechanisms play in the auditory pathway. This detailed explanation often must be re-iterated and paraphrased at intervals. Counseling must come from a knowledgeable yet compassionate source. It must be conducted according to the guidelines of TRT as described by Dr. Jastreboff and Dr. Hazell, and the counselor must be thoroughly versed in the principles of TRT. The counselor must also be willing to be reasonably accessible to the patient and the patient must be willing to follow through on the counselor’s recommendations, and not discontinue the program prematurely. Most patients see some levels of improvement in 8 weeks