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Id 9870df96-db72-47b9-99a6-5234540e57dd

Year 2023

Abstract

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(Suraj et al., 2023)

Import Date 05-08-2026

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Dv Authors Urs Suraj, Kavassery Venkateswaran Nisha, Prashanth Prabhu,

Dv Initial Source Misophonia MOC

Dv Status #status/Bare-bones-review

Dv Limitations • Only mild and moderate severity included; severe misophonia not represented. • Cognitive, psychological, and environmental contributors not assessed.

Dv Future Directions • Use auditory evoked potentials to probe central auditory processing. • Use functional neuroimaging to investigate central correlates. • Explore additional non-auditory contributors (cognitive, psychological, environmental). - [ ]

Dv Relevance • a rare example of published null results. was looking at some audiological things in the context of Misophonia but didn't find any differences between Misophonics and controls.

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Normal linear and non-linear cochlear mechanisms and efferent system functioning in individuals with misophonia

Status:: #status/Bare-bones-review

Metadata

Item Type: #journalArticle
Authors:: Urs Suraj, Kavassery Venkateswaran Nisha, Prashanth Prabhu,
Date Added: October 18, 2023
URL: https://link.springer.com/10.1007/s00405-023-08273-6
DOI: 10.1007/s00405-023-08273-6
Cite Key: surajNormalLinearNonlinear2023
Tags:: #Misophonia, #Bare-bones-review-🦴, #audiology, #Efferent-system, #Suppression, #Otoacoustic-emissions, #null-results,
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Abstract


Background/Purpose	Background- • Misophonia not recognized as distinct disorder in DSM-V or ICD-11. • Multifaceted condition involving cognitive, emotional, and sensory processes. • Neuro-audiological model implicates abnormal auditory cortex activity, non-classical pathway, limbic system, and autonomic hyperactivation via classical conditioning. • Hypothesized pathophysiological overlap with tinnitus and hyperacusis. • Tinnitus literature shows abnormal/absent TEOAEs, lower DPOAE amplitudes, and altered MOCB function (hyperresponsive in tinnitus + hyperacusis). Purpose- • Assess linear OHC functioning in misophonia via TEOAEs. • Assess non-linear OHC functioning in misophonia via DPOAEs. • Assess auditory efferent (MOCB) functioning via contralateral suppression of TEOAEs and DPOAEs.
Participants/samples	• 40 ears with misophonia (20 participants; 2 male, 18 female). • 37 ears without misophonia (20 participants; 7 male, 13 female). • Age range 18–28 years. • Inclusion: normal hearing (<15 dB HL air/bone), 'A' type tympanogram, present ipsi/contralateral acoustic reflexes at 500/1000 Hz. • Exclusion: hearing loss, otologic deficits, neurological disorders, tinnitus, vestibular migraine, hyperacusis, musical training, hearing aid history. • Misophonia confirmed via Schröder et al. (2013) diagnostic criteria; severity via MAQ (mild and moderate only included).
Measures	• Pure-tone audiometry (air and bone conduction). • Tympanometry and acoustic reflexes. • MAQ (severity). • TEOAEs (global amplitude; band amplitudes at 1, 1.5, 2, 3, 4 kHz). • DPOAEs (band amplitudes at 1, 1.5, 2, 3, 4 kHz). • Contralateral suppression for both TEOAEs and DPOAEs.
Procedures	• Acoustically treated, electrically shielded room. • TEOAEs: non-linear pulse train clicks ~80 dB peak SPL, 80 μs duration, flat spectrum; reproducibility ≥80% required. • DPOAEs: f2/f1 = 1.22; L1 = 65 dB SPL, L2 = 55 dB SPL. • Contralateral suppression: white noise 50 dB SPL via insert earphone; suppression amplitude = OAE amplitude (no noise) − OAE amplitude (with noise). • ILO V6 system (Otodynamics) for OAE recording.
Results	• No group difference in TEOAE absolute amplitudes (global or band-specific). • No group difference in DPOAE absolute amplitudes across frequencies. • No group difference in TEOAE contralateral suppression amplitude at any frequency. • No group difference in DPOAE contralateral suppression amplitude at any frequency.
Discussion/Limits	Conclusion- • The findings indicate linear and non-linear OHC functioning is intact in misophonia. • The findings indicate MOCB efferent functioning in misophonia is comparable to controls. • The authors conclude the pathophysiology of misophonia is not related to cochlear or MOCB mechanisms. • The data support a more central locus for misophonia, possibly beyond the brainstem, consistent with prior cortical AEP, MMN, and fMRI evidence (diminished N1, reduced MMN, altered insula/ACC/amygdala/auditory cortex activity, greater ventral attention network connectivity). • The authors conclude misophonia, despite hypothesized overlap with tinnitus and hyperacusis, does not seem to share their peripheral inner ear or efferent involvement.
Limitations::	• Only mild and moderate severity included; severe misophonia not represented. • Cognitive, psychological, and environmental contributors not assessed.
Future Directions::	• Use auditory evoked potentials to probe central auditory processing. • Use functional neuroimaging to investigate central correlates. • Explore additional non-auditory contributors (cognitive, psychological, environmental). - [ ]
Relevance::	• a rare example of published null results. was looking at some audiological things in the context of Misophonia but didn't find any differences between Misophonics and controls.

Notes

key terms and concepts

Misophonia – condition characterized by heightened sensitivity and strong emotional reactions to specific sounds; per Schröder et al. (2013), specific sounds (or anticipation of such sounds) immediately evoke feelings of irritation or disgust that escalate anger.
TEOAEs (Transient Evoked Otoacoustic Emissions) – low level responses produced by OHCs following a brief acoustic stimulus (clicks/tone bursts); index linear OHC functioning.
DPOAEs (Distortion Product Otoacoustic Emissions) – sounds emitted by OHCs in response to two simultaneous pure tones (f1, f2; f2/f1 = 1.22); index non-linear OHC functioning.
MOCB (Medial Olivocochlear Bundle) – auditory efferent pathway; assessed via contralateral suppression of OAEs.
Suppression amplitude – difference in OAE amplitude between conditions with and without contralateral noise stimulation.
MAQ (Misophonia Assessment Questionnaire) – 21-item severity measure; mild (0–21), moderate (22–42), severe (43–63).

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Sex imbalance

Misophonia group skewed strongly female (18F/2M); control more balanced (13F/7M). Not addressed analytically.

Severity restriction

Severe misophonics excluded by recruitment outcome, not design — limits inference about whether peripheral effects might emerge at higher severity.

Tinnitus framing

Authors lean heavily on tinnitus/hyperacusis as the comparison condition justifying peripheral hypothesis (Knudson et al., 2014 hyperresponsive MOCB in tinnitus+hyperacusis).

contextual statement

In a 2023 study, Suraj attempted to characterize peripheral cochlear and efferent auditory functioning in misophonia by recording TEOAEs, DPOAEs, and contralateral OAE suppression in 40 ears of normal-hearing individuals with mild-to-moderate misophonia and 37 control ears.

zettlekasten

Surja findings of normal audiological functioning in Misophonia