Auditory Processing and Neuroregulation in Misophonia: A Comparative Study of Behavioral Measures
DOI:
https://doi.org/10.15540/nr.12.3.172Keywords:
Misophonia, Masking level difference, Auditory processing abilities, Binaural integrationAbstract
Misophonia is a condition of intolerance to certain sounds which act as triggers. This study investigates auditory processing abilities using behavioral measures in normal-hearing individuals with and without misophonia. Thirty participants aged between 18 and 30 years were included. They were divided into two primary groups: 15 individuals diagnosed with misophonia and 15 controls. All of the participants underwent auditory processing tests such as masking level difference (MLD), dichotic consonant-vowel (DCV), and pitch pattern tests (PPT). From the analyzed data, individuals with misophonia showed significantly reduced scores in DCV and PPT. Also, there was no significant difference in the thresholds of MLD at 500 Hz. This study highlights that the reduced scores of DCV and PPT in individuals with misophonia could be attributed to poor auditory cortical processing compared to the control group.
References
Aazh, H., Landgrebe, M., Danesh, A. A., & Moore, B. C. (2019). Cognitive behavioral therapy for alleviating the distress caused by tinnitus, hyperacusis, and misophonia: Current perspectives. Psychology Research and Behavior Management, 12, 991–1002. https://doi.org/10.2147/PRBM.S179138
Allusoglu, S., & Aksoy, S. (2022). The reliability and validity of the decreased sound tolerance scale-screening. Brazilian Journal of Otorhinolaryngology, 88(Suppl. 3), S155–S163. https://doi.org/10.1016/j.bjorl.2021.11.009
Aryal, S., & Prabhu, P. (2022). Misophonia: Prevalence, impact and co-morbidity among Mysore University students in India - A survey. Neuroscience Research Notes, 5(4), 1–9. https://doi.org/10.31117/neuroscirn.v5i4.161
Aryal, S., & Prabhu, P. (2023a). Auditory brainstem functioning in individuals with misophonia. Journal of Otology, 18(3), 139–145. https://doi.org/10.1016/j.joto.2023.05.006
Aryal, S., & Prabhu, P. (2023b). Auditory cortical functioning in individuals with misophonia: An electrophysiological investigation. European Archives of Oto-Rhino-Laryngology, 281, 2259–2273. https://doi.org/10.1007/s00405-023-08318-w
Aryal, S., & Prabhu, P. (2023c). Understanding misophonia from an audiological perspective: A systematic review. European Archives of Oto-Rhino-Laryngology, 280, 1529–1545. https://doi.org/10.1007/s00405-022-07774-0
Bellis, T. J. (2011). Assessment and management of central auditory processing disorders in the educational setting: From science to practice (2nd ed.). Plural.
Brennan, C. R., Lindberg, R. R., Kim, G., Castro, A. A., Khan, R. A., Berenbaum, H., & Husain, F. T. (2023). Misophonia and hearing comorbidities in a collegiate population. Ear and Hearing, 45(2), 390–399. https://doi.org/10.1097/AUD.0000000000001435
Brout, J. J., Edelstein, M., Erfanian, M., Mannino, M., Miller, L. J., Rouw, R., Kumar, S., & Rosenthal, M. Z. (2018). Investigating misophonia: A review of the empirical literature, clinical implications, and a research agenda. Frontiers in Neuroscience, 12(36), Article 36. https://www.doi.org/10.3389/fnins.2018.00036
Carhart, R., & Jerger, J. (1959). Preferred method for clinical determination of pure-tone thresholds. Journal of Speech & Hearing Disorders, 24(4), 330–345. https://doi.org/10.1044/jshd.2404.330
Cavanna, A. E., & Seri, S. (2015). Misophonia: current perspectives. Neuropsychiatric Disease and Treatment, 11, 2117–2123. https://doi.org/10.2147/NDT.S81438
Chermak, G. D., & Musiek, F. E. (1997). Central auditory processing disorders: New perspectives. Singular.
da Silva, F. E., & Sanchez, T. G. (2019). Evaluation of selective attention in patients with misophonia. Brazilian Journal of Otorhinolaryngology, 85(3), 303–309. https://doi.org/10.1016/j.bjorl.2018.02.005
Danesh, A., & Aazh, H. (2020). Misophonia: A neurologic, psychologic, and audiologic complex. The Hearing Journal, 73(3), 20, 22, 23. https://doi.org/10.1097/01.HJ.0000657984.74790.d5
Daniels, E. C., Rodriguez, A., & Zabelina, D. L. (2020). Severity of misophonia symptoms is associated with worse cognitive control when exposed to misophonia trigger sounds. PLoS ONE, 15(1), Article e0227118. https://doi.org/10.1371/journal.pone.0227118
Dixon, L. J., Schadegg, M. J., Clark, H. L., Sevier, C. J., & Witcraft, S. M. (2024). Prevalence, phenomenology, and impact of misophonia in a nationally representative sample of US adults. Journal of Psychopathology and Clinical Science, 133(5), 403–412. https://doi.org/10.1037/abn0000904
Eijsker, N., Schröder, A., Smit, D. J., van Wingen, G., & Denys, D. (2021). Structural and functional brain abnormalities in misophonia. European Neuropsychopharmacology, 52, 62–71. https://doi.org/10.1016/j.euroneuro.2021.05.013
Gowda, V., & Prabhu, P. (2024). Prevalence of misophonia in adolescents and adults across the globe: A systematic review. Indian Journal of Otolaryngology and Head & Neck Surgery, 76(5), 4614–4622. https://doi.org/10.1007/s12070-024-04946-8
Hansen, H. A., Leber, A. B., & Saygin, Z. M. (2021). What sound sources trigger misophonia? Not just chewing and breathing. Journal of Clinical Psychology, 77(11), 2609–2625. https://doi.org/10.1002/jclp.23196
Ila, K., Soylemez, E., Yilmaz, N., Ertugrul, S., Turudu, S., Karaboya, E., & Adıgul, Ç. (2023). Assessment of temporal auditory processing in individuals with misophonia. Hearing, Balance and Communication, 21(4), 286–290. https://doi.org/10.1080/21695717.2023.2169373
Jager, I., de Koning, P., Bost, T., Denys, D., & Vulink, N. (2020). Misophonia: Phenomenology, comorbidity and demographics in a large sample. PLoS ONE, 15(4), Article e0231390. https://doi.org/10.1371/journal.pone.0231390
Jastreboff, M. M., & Jastreboff, P. J. (2001) Components of decreased sound tolerance: Hyperacusis, misophonia, phonophobia. Audiology Online. http://www.baillement.com/lettres/jastreboff_mysophonia.pdf
Jastreboff, M. M., & Jastreboff, P. J. (2002). Decreased sound tolerance and tinnitus retraining therapy (TRT). Australian and New Zealand Journal of Audiology, 24(2), 74–84. https://doi.org/10.1375/audi.24.2.74.31105
Jastreboff, P. J., & Jastreboff, M. M. (2003). Tinnitus retraining therapy for patients with tinnitus and decreased sound tolerance. Otolaryngologic Clinics of North America, 36(2), 321–336. https://doi.org/10.1016/S0030-6665(02)00172-X
Jastreboff, P. J., & Jastreboff, M. M. (2014). Treatments for decreased sound tolerance (hyperacusis and misophonia). Thieme: Seminars in Hearing, 35(2), 105–120. https://doi.org/10.1055/s-0034-1372527
Jastreboff, P. J., & Jastreboff, M. M. (2023). The neurophysiological approach to misophonia: Theory and treatment. Frontiers in Neuroscience, 17, Article 895574. https://doi.org/10.3389/FNINS.2023.895574
Kemp, D. T. (2007). The basics, the science, and the future potential of otoacoustic emissions. Otoacoustic emissions: Clinical applications (3rd ed.). Thieme Medical Publishers, Inc, 7–42.
Khalfa, S., Dubal, S., Veuillet, E., Perez-Diaz, F., Jouvent, R., & Collet, L. (2002). Psychometric normalization of a hyperacusis questionnaire. ORL, 64(6), 436–442. https://doi.org/10.1159/000067570
Kim, G., Lindberg, R., Jain, N., & Husain, F. T. (2023). Speech in noise performance in individuals with misophonia and hyperacusis using behavioral and auditory brainstem response. The Journal of the Acoustical Society of America, 153(Suppl. 3), A160. https://doi.org/10.1121/10.0018510
Kumar, S., Hancock, O. T., Sedley, W., Winston, J. S., Callaghan, M. F., Allen, M., Cope, T. E., Gander, P. E., Bamiou, D. E., & Griffiths, T. D. (2017). The brain basis for misophonia. Current Biology, 27(4), 527–533. https://doi.org/10.1016/j.cub.2016.12.048
Kumar, S., Dheerendra, P., Erfanian, M., Benzaquen, E., Sedley, W., Gander, P. E., Lad, M., Bamiou, D. E., & Griffiths, T. D. (2021). The motor basis for misophonia. The Journal of Neuroscience, 41(26), 5762–5770. https://doi.org/10.1523/JNEUROSCI.0261-21.2021
Madappally, H. V., Nisha, K. V., & Prabhu, P. (2024). Do individuals with misophonia experience challenges with their auditory binaural interaction and integration skills? Auditory and Vestibular Research, 34(1), 28–36. https://doi.org/10.18502/avr.v34i1.17269
Neacsiu, A. D., Szymkiewicz, V., Galla, J. T., Li, B., Kulkarni, Y., & Spector, C. W. (2022). The neurobiology of misophonia and implications for novel, neuroscience-driven interventions. Frontiers in Neuroscience, 16, Article 893903. https://doi.org/10.3389/fnins.2022.893903
Newman, C. W., Jacobson, G. P., & Spitzer, J. B. (1996). Development of the tinnitus handicap inventory. Archives of Otolaryngology–Head & Neck Surgery, 122(2), 143–148. https://doi.org/10.1001/archotol.1996.01890140029007
Olsen, W. O., Noffsinger, D., & Carhart, R. (1976). Masking level differences encountered in clinical populations. Audiology, 15(4), 287–301. https://doi.org/10.3109/00206097609071789
Patel, N. M., Fameen, R., Shafeek, N., & Prabhu, P. (2023). Prevalence of misophonia in college going students of India: A preliminary survey. Indian Journal of Otolaryngology and Head & Neck Surgery, 75(2), 374–378. https://doi.org/10.1007/s12070-022-03266-z
Pellicori, J. (2020). Clinician’s guide to misophonia. Audiology Online, Article 27026. https://www.audiologyonline.com/articles/clinician-s-guide-to-misophonia 27099
Roeser, R. J., Valente, M., & Hosford-Dunn, H. (2007). Audiology. Diagnosis (2nd ed.). Thieme.
Rouw, R., & Erfanian, M. (2018). A large‐scale study of misophonia. Journal of Clinical Psychology, 74(3), 453–479. https://doi.org/10.1002/jclp.22500
Schröder, A. E., Mazaheri, A., Petropoulos, D., Soto, V., Smolders, R., Vulink, N. C. C., & Denys, D. (2013b). P.1.b.005 A diminished mismatch negativity response in misophonia, a potential marker for aggressive impulsivity. European Neuropsychopharmacology, 23(Suppl. 2), S177. https://doi.org/10.1016/S0924-977X(13)70269-4
Schröder, A., San Giorgi, R., Van Wingen, G., Vulink, N., & Denys, D. (2015). P.1.i.015 Impulsive aggression in misophonia: results from a functional magnetic resonance imaging study. European Neuropsychopharmacology, 25(2), S307–S308. https://doi.org/10.1016/S0924-977X(15)30374-6
Schröder, A., van Diepen, R., Mazaheri, A., Petropoulous-Petalas, D., Soto de Amesti, V., Vulink, N., & Denys, D. (2014). Diminished N1 auditory evoked potentials to oddball stimuli in misophonia patients. Frontiers in Behavioral Neuroscience, 8(123), 1–6. https://doi.org/10.3389/fnbeh.2014.00123
Schröder, A., van Wingen, G., Eijsker, N., San Giorgi, R., Vulink, N. C., Turbyne, C., & Denys, D. (2019). Misophonia is associated with altered brain activity in the auditory cortex and salience network. Scientific Reports, 9(1), Article 7542. https://doi.org/10.1038/s41598-019-44084-8
Schröder, A., Vulink, N., & Denys D. (2013a). Misophonia: Diagnostic criteria for a new psychiatric disorder. PLoS ONE, 8(1), Article e54706 https://doi.org/10.1371/journal.pone.0054706
Siepsiak, M., Śliwerski, A., & Łukasz Dragan, W. (2020). Development and psychometric properties of misoquest—A new self-report questionnaire for misophonia. International Journal of Environmental Research and Public Health, 17(5), Article 1797. https://doi.org/10.3390/ijerph17051797
Sujeeth, P. R., Hanji, R., Nayyar, K., & Prabhu, P. (2023). Estimation of prevalence of misophonia among high school students in India. Indian Journal of Otolaryngology and Head & Neck Surgery, 76(2), 1678–1681. https://doi.org/10.1007/s12070-023-04382-0
Swedo, S. E., Baguley, D. M., Denys, D., Dixon, L. J., Erfanian, M., Fioretti, A., Jastreboff, P. J., Kumar, S., Rosenthal, M. Z., Rouw, R., Schiller, D., Simner, J., Storch, E. A., Taylor, S., Werff, K. R. V., Altimus, C. M., & Raver, S. M. (2022). Consensus definition of misophonia: A Delphi study. Frontiers in Neuroscience, 16, Article 841816. https://doi.org/10.3389/FNINS.2022.841816
Task Force on Central Auditory Processing Consensus Development. (1996). Central auditory processing: Current status of research and implications for clinical practice. American Journal of Audiology, 5(2), 41–52. https://doi.org/10.1044/1059-0889.0502.41
Tiwari, S. (2003). Maturational effect of pitch pattern sequence test (No IP441) [Dissertation]. Mysore: All India Institute of Speech and Hearing.
Williams, Z. J., Cascio, C. J., & Woynaroski, T. G. (2022). Psychometric validation of a brief self-report measure of misophonia symptoms and functional impairment: The duke-vanderbilt misophonia screening questionnaire. Frontiers in Psychology, 13, Article 897901. https://doi.org/10.3389/fpsyg.2022.897901
Yadav, N., Aryal, S., Gupta, D. K., Kaushik, C., & Prabhu, P. (2024). Prevalence of misophonia and its characteristics among amity university students in India. Indian Journal of Otology, 30(2), 90–95. https://doi.org/10.4103/indianjotol.indianjotol_117_23
Yathiraj, A. (1999). The dichotic CV test. Mysore, India: Department of Audiology, All India Institute of Speech and Hearing.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Kamalakannan Karupaiah, Prashanth Prabhu

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
