By Szabina T. Wagner4 min read
Maybe you are here to get some answers- you know your own experience but you wonder where you fit in? You feel distressed by sounds but which one is it? Hyperacusis or Misophonia?
Firstly, keep in mind that both Hyperacusis and Misophonia are forms of sound intolerance. Both conditions have their own characteristics but, as my supervisor says, they are not “this one is a triangle and other is a square”- so there are no hard borders between the two, they have many similarities, they overlap and mesh into each other.
My intention is not to give you a specific diagnoses but to introduce the differences between Hyperacusis and Misophonia. Hopefully, this can help you to place your experience on the spectrum of sound intolerance.
These are any such sounds you find hard to tolerate. In the case of Hyperacusis, the trigger is always a sound and the most triggering is the loudness of the sound. Compared to this, if you have Misophonia, it is not the loudness that you react the most, but the nature of the sound. Moreover, in Misophonia the emotional response can be triggered by visual signs as well, before you even hear the sound you already feel for example, disgusted by the sight of someone’s chewing on a piece of meat.
Because the main symptom of Hyperacusis is the reduced tolerance toward the loudness of the sound, audiologist can conduct a test to measure the level where you start finding the loudness too much. This test is called “ULL”, uncomfortable loudness level. Nowadays many clinicians find the test unnecessary as it can be very stressful for patients (after all, the trigger is the loudness…imagine to sit there and try to bear it…) and it is very subjective. Research is ongoing in this field to find more suitable methods to help diagnose Hyperacusis.
While with Hyperacusis any sound can feel too loud: water dripping from a tap, people chatting around you, fans hissing endlessly, those who experience Misophonia react to man-made sounds. Your co-worker is clicking a pen, your dog is breathing in an annoying way, your partner is slurping tea and so on. These are all noises that someone makes. Typical Misophonia triggers are eating, breathing noises , tapping, clicking, yawning. If you have Misophonia, you might feel totally fine about using a loud machine such as a hand-dryer in a public toilet but you feel beside yourself when someone is crunching crisps in front of you. Compared to this, if you experience Hyperacusis, you run from the hand-dryer but you can sit through a family dinner, provided no-one is too loud.
Now that we analysed the triggers, let’s move on to emotional responses. Frustration is common in both condition as an initial reaction. However, in Hyperacusis people often experience fear (fear from how the loudness of the sound can hurt them) and pain in the ear as well. Bodily sensations such as headache are also more usual with Hyperacusis. In contrast, Misophonia comes with anger and disgust, and sometimes the anger can become a raging outburst against the person who made the triggering noise. These initial emotions often feel overwhelming in both conditions and they are followed by more negative feelings such as anxiety (what will happen now?) , guilt and embarrassment (why can’t I be like others?) and a downward dive of mood ( this is ruining my life).
These emotional responses lead to certain behaviours. If you have Hyperacusis, you might feel the urge to protect your hearing, cover your ears, put on earplugs. If you are misophonic ( not sure this is an actual word!) you may try to “ stare down” the offender- they might just stop crunching that apple if you stare at them long enough. Ultimately, whatever the trigger was, people often just try to escape from it as soon as possible.
Lastly, the question of how it all started. This is usually difficult to pin-point but the distinctive feature is that Misophonia can appear early on and there might be periods when it is less of an issue but the first instances occur during teenager years. Hyperacusis can have a sudden onset after an event that affected the hearing (sudden hearing loss, head injury, ear infections etc) or gradual increase of sensitivity over time. Hyperacusis can be present without measurable hearing loss but it is a sign of change in how neurons respond to the loudness of sounds.
Perhaps not all of your experience can be neatly put in the category of Hyperacusis or Misophonia. In my opinion, that is how we humans are: mostly the same and yet so different. Perhaps this article helped you clarify a few things. It is not easy to understand ourselves but it can be very rewarding. Any form of sound intolerance can have huge impact on your life but you can understand your own experience better, you can find people similar to you, and you can find support how to make sure you are in charge of your life, not a bunch of sounds and a handful of negative emotions.
Further reading on diagnostic tools and research:
Validating and refining a psychoacoustic test to diagnose hyperacusis - ScienceDirect
3 min read
Do you find it hard to tolerate certain sounds? Are you using earplugs to protect your hearing? Are you wearing your headphones everywhere? Well, you might make your hyperacusis and misophonia worse…
Read more: Headphones, earplugs and central gain theory: a honey-trap for sound intolerance