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Id 0496d0df-4f43-4ebb-9b88-7ff15e2918f8

Dv Needs Attention true

Dv Attention Details needs import cleaning

Dv Status #status/Bare-bones-review

Checked For Zettle Notes true

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Aliases

(Jastreboff & Jastreboff, 2014)

Dv Initial Source Misophonia MOCMisophonia

Dv Limitations • No validated, condition-specific diagnostic tools or standardized outcome measures. • Results from a single clinical center; no randomized control data presented. • No follow-up duration data—long-term efficacy unknown. • Misophonia evaluation depends entirely on interview-based self-report.

Dv Future Directions • Need for development and validation of specific diagnostic instruments, especially for misophonia. • Need for controlled studies to compare TRT with other treatment approaches. • Development of animal models for DST to support mechanistic research.

Dv Relevance • Has significant rebuttal to the 42 subject Schroder study. Shows the pros and cons to many proposed mechanisms of DST. Describes factors to consider when contemplating possible mechanisms for DST and Misophonia. • Gives descriptions of the neurology of DST, hyperacusis, and Misophonia. Provides description of/explanation of TRT (tinnitus retraining therapy). • Describes treatment, including several different protocols, for use of sound therapy to treat Misophonia. Highly valuable resource

Treatments for Decreased Sound Tolerance (Hyperacusis and Misophonia)

Status:: #status/Bare-bones-review

Metadata

Item Type: #journalArticle
Authors: Pawel Jastreboff, Margaret Jastreboff
Date: 2014-4-29
Date Added: 2020-01-15
URL: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1372527
DOI: 10.1055/s-0034-1372527
Cite key: jastreboffTreatmentsDecreasedSound2014
Topics: primary Resources
Tags: #Misophonia
PDF Attachments
- R26 Using TRT to treat hyperacusis, misophonia and phonophobia.pdf

Abstract

Decreased sound tolerance (DST) is an underappreciated condition that affects the lives of a signiﬁcant portion of the general population. There is lack of agreement regarding deﬁnitions, speciﬁc components, prevalence, methods of evaluation, and methods of treatment. Limited data are available on the results of treatments. Research is scant and constrained by the lack of an animal model. This article proposes a deﬁnition of DST and its division into hyperacusis and misophonia. The potential mechanisms of these phenomena are outlined, and the results of treatment performed at Emory University are presented. Out of 201 patients with DST, 165 (82%) showed signiﬁcant improvement. Of 56 patients with hyperacusis (with or without misophonia), 45 (80%) showed signiﬁcant improvement. This proportion was higher for the group with hyperacusis and concurrent misophonia (33 of 39, or 85%) and lower for patients with hyperacusis only (13 of 17, or 76%). Effectiveness of treatment for misophonia with or without hyperacusis was identical (152 of 184, 83% and 139 of 167, 83%, respectively, for misophonia accompanied by hyperacusis and for misophonia only). Even with current limited knowledge of DST, it is possible to propose speciﬁc mechanisms of hyperacusis and misophonia and, based on these mechanisms, to offer treatments in accordance with the neurophysiological model of tinnitus. These treatments are part of Tinnitus Retraining Therapy (TRT), which is aimed at concurrently treating tinnitus and DST and alleviating the effects of hearing loss. High effectiveness of the proposed treatments support the postulated mechanisms.

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Article Review table


Background/Purpose	Background- • DST is under-recognized, with poorly defined diagnostic criteria and limited data on prevalence, etiology, and treatment outcomes. • Previous terminological confusion has hindered consistent classification and understanding. • Lack of animal models restricts experimental validation of proposed mechanisms. • Hyperacusis and misophonia are often conflated, but involve different neurophysiological mechanisms and require distinct treatments. Purpose- • To define DST and clarify distinctions between hyperacusis and misophonia. • To propose neurophysiological mechanisms underlying each condition. • To present treatment strategies based on these mechanisms. • To report clinical outcomes from Emory University’s Tinnitus and Hyperacusis Center using TRT-based protocols. • Propose a definition for “decreased sound tolerance” (DST) and its division into hyperacusis and Misophonia, describe potential mechanisms for the condition, describe the results of a treatment study using tinnitus retraining therapy (TRT).
Participants/samples	• 201 patients with DST from Emory Tinnitus and Hyperacusis Center. • 184 patients (92%) had misophonia; 56 patients (28%) had hyperacusis, of whom 39 also had misophonia. • No detailed demographic data provided; the population included both isolated and comorbid presentations.
Measures	• Questionnaires: •Hyperacusis Questionnaire and Multiple-Activity Scale for Hyperacusis (MASH) used but found inadequate due to lack of specificity. • No validated questionnaire exists for misophonia. • Audiological Tests: • Loudness Discomfort Levels (LDLs) used to assess hyperacusis. • Misophonia not assessable via LDLs—requires structured interviews. • Behavioral Ratings: • Structured interview ratings of severity, annoyance, and functional impact of DST.
Procedures	• Sound therapy protocols within the TRT framework. • Hyperacusis: gradual exposure to non-annoying sound to decrease central auditory gain. • Misophonia: conditioning protocols aimed at weakening reflexive negative associations with specific sounds via: • Patient-controlled exposure to preferred sounds (Protocol 1) • Shared control of sound environment (Protocol 2) • Real-world exposure with no sound control (Protocol 3) • Systematic desensitization with offensive + positive sound pairing (Protocol 4) • Tailoring protocols based on patient’s level of control, emotional response, and environmental triggers.
Results	• Overall treatment success (defined as significant improvement): 165/201 patients (82%). • Hyperacusis (with/without misophonia): 45/56 patients (80%) improved. • Hyperacusis + misophonia: 85% improved. • Hyperacusis alone: 76% improved. • Misophonia (with/without hyperacusis): 83% success rate in both subgroups. • Some patients were cured entirely of DST symptoms.
Discussion/Limits	Conclusion- • High success rates support the neurophysiological model distinguishing hyperacusis and misophonia. • Hyperacusis arises from increased central auditory gain; treatable via controlled sound exposure. • Misophonia involves aberrant limbic-auditory connections governed by conditioned reflexes; requires reconditioning strategies. • TRT-based approach is effective for both conditions, especially when treatments are tailored to individual symptom profiles.
Limitations::	• No validated, condition-specific diagnostic tools or standardized outcome measures. • Results from a single clinical center; no randomized control data presented. • No follow-up duration data—long-term efficacy unknown. • Misophonia evaluation depends entirely on interview-based self-report.
Future Directions::	• Need for development and validation of specific diagnostic instruments, especially for misophonia. • Need for controlled studies to compare TRT with other treatment approaches. • Development of animal models for DST to support mechanistic research.
Relevance::	• Has significant rebuttal to the 42 subject Schroder study. Shows the pros and cons to many proposed mechanisms of DST. Describes factors to consider when contemplating possible mechanisms for DST and Misophonia. • Gives descriptions of the neurology of DST, hyperacusis, and Misophonia. Provides description of/explanation of TRT (tinnitus retraining therapy). • Describes treatment, including several different protocols, for use of sound therapy to treat Misophonia. Highly valuable resource

key terms

Decreased Sound Tolerance (DST) – a condition in which individuals experience negative reactions to sounds that are not bothersome to the average person. DST is composed of two distinct subtypes: hyperacusis and misophonia.
Hyperacusis – negative reaction to sound based solely on its physical characteristics (intensity and spectrum), independent of context or meaning.
Misophonia – abnormal emotional and physiological response to specific patterns or meanings of sound, often context-dependent.
Phonophobia – a subtype of misophonia where fear is the dominant emotional response to specific sounds.
Loudness Discomfort Levels (LDLs) – audiological measurement of the sound intensity at which a subject reports discomfort; used to help assess hyperacusis.
Tinnitus Retraining Therapy (TRT) – a treatment approach based on the neurophysiological model of tinnitus that uses sound therapy and counseling to reduce negative reactions to sound.
Complex Conditioned Stimulus – in misophonia, a therapeutic construct where an offensive sound is paired with positive stimuli to recondition emotional responses.
Tensor Tympani Syndrome – symptoms such as ear pain, fullness, or pulsation due to overactivation of the tensor tympani muscle; often associated with severe misophonia.

Misc notes

Diagnostic Challenges

Misophonia and hyperacusis often co-occur, complicating diagnosis.
LDLs can be misleading due to misophonia; structured interviews are crucial.

Treatment Considerations

Earplug overuse can worsen hyperacusis due to reduced auditory input and increased gain.
Counseling is central to all protocols—psychoeducation about mechanisms helps reduce fear-based avoidance.
Exposure protocols for misophonia must incorporate environmental, contextual, and multisensory cues for effective desensitization.

Theoretical Contributions

The use of conditioned reflex extinction principles provides a clear behavioral mechanism for misophonia treatment.
Emphasis on stimulus generalization and positive reinforcement aligns treatment with foundational learning theory.

Zettlekasten

2014 report of successful Misophonia treatment using tinnitus retraining therapy