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A Case of Amplified Misophonia? by Dennis A HEARING MATTERS A Case of Amplified Misophonia? By Dennis A. Colucci, AuD, MA atients who have long-standing hearing loss—with or AC: Supra-Aural, BC: B71 without tinnitus, recruitment, or mildly reduced un- 125 250 500 1k 2k 4k 8k 16k comfortable loudness levels (UCLs)—may have diffi- -20 culty adjusting to new amplification. -10 PIn such situations, the normal course of action is to provide 0 a therapeutic regimen that gradually develops gain and output 411154 10 expansion to include the use of compression and noise re- 20 duction, while supporting adaptation and neuroplasticity with sound therapy and directive counseling. However, when the 30 40 patient cannot adapt and a severe reaction to suprathreshold el (dB) v sound or sound types ensues, a sound sensitivity disorder 50 such as misophonia or hyperacusis should be considered. ing le 60 Although sound sensitivity disorders frequently appear in 70 Hear combination, misophonia is unique. In people with the condi- 80 7/22/2013 3:30:50 PM S/N: tion, certain types of sounds trigger an emotional response, 90 even if hearing sensitivity and UCLs are within normal limits. 100 The reaction ranges from irritation to aggression, including 110 Calibrated: discomfort, disgust, anger, depression, anxiety, and outbursts. According to Gabriela M. Ferreira, MD, and colleagues, miso- 120 phonia may be a result of an underlying psychological etiol- 750 1.5k 3k 6k 12.5k ogy (Ann Clin Psychiatry 2013;25[4]:271-274), and the Frequency (Hz) assistance of a cognitive behavioral therapist may be neces- The patient’s audiogram and UCL measures showed sary. these results The sound of nails scraping on a chalkboard bothers most of us, but, for the patient with misophonia, this sound be- difficulty, even though the bilateral, severe high-frequency comes incomprehensibly intolerable. Misophonia triggers can sensorineural hearing loss has gone untreated for many years. be body sounds made by others, such as lip smacking, chew- The cause of the hearing loss is age plus noise exposure ing, heavy breathing, or nasal sounds, or environmental from dental and farm equipment. UCLs are within normal lim- sounds, such as typing, scraping, nail clipping, pen clicking, its, but recruitment is evident. Profiling the patient reveals a or footsteps (PLoS One 2013;8[1]:e54706). cooperative professional willing to work on developing better In patients who have long-standing high-frequency hearing hearing, with a type-A personality. loss and need amplification, misophonia may rear its ugly Once the patient is fitted, speech becomes clearer, but head, and a hearing aid return for credit is imminent unless issues of sound annoyance and dislike ensue. He cannot tol- actions to treat the disorder are part of the process. erate high-frequency sounds, such as clicking, tapping, and The therapeutic goal for these patients is to use cognition lip smacking. Most importantly, he dislikes hearing the spoken and experience to influence the subconscious brain and lim- /s/, /t/, /ch/, and /sh/ sounds. bic system, making the triggering sounds unimportant or neu- Counseling, sound therapy, mimicry instructions, sound tral. One way to accomplish this objective is having the patient blending, and various coping strategies are repeatedly re- mimic the body sounds he or she dislikes in order to learn viewed. Prescriptively, the hearing aids are programmed for control and acceptance. More training on this topic is avail- multiple scenarios with graduated gain, bandpass filtering able from the Tinnitus Practitioners Association. routines, controlled output and compression, noise reduction, directionality, and volume control. After six months of therapy, the patient stops using the hear- HEARING LOSS WITH RECRUITMENT ing aids and sound devices, claiming that the release from dis- A case in point is that of an 80-year-old patient with habitu- comfort and annoyance is much more enjoyable than hearing. ated tinnitus who seeks help with communication and control Although this is an extreme example, applying amplification over his exceptionally loud voice. The Abbreviated Profile of to patients with significant long-standing hearing loss who are Hearing Aid Benefit (APHAB) reveals only slight hearing uncharacteristically reactive to specific sounds may be a case of amplified misophonia. Anecdotally, removing the hearing Dr. Colucci is a clinical and forensic audiologist in private practice aids and working with noise generators and sound therapy in Laguna Hills, CA. before reintroducing the hearing aids may be an alternative avenue for patient management. Certainly, more research is needed in this area. 40 The Hearing Journal February 2015.
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