Introduction

Sound sensitivity disorders can significantly affect daily life, but not all sound sensitivity is the same. Two conditions that are frequently confused — or used interchangeably — are misophonia and hyperacusis. While both involve an abnormal reaction to sound, they differ in their triggers, neurological mechanisms, and emotional responses. Understanding which condition you have is important because the treatment approaches differ. This guide explains the key differences between misophonia and hyperacusis, how each is diagnosed, and what treatment options exist for each.

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What Is Misophonia?

Misophonia — literally “hatred of sound” — is a condition in which specific sounds trigger intense emotional reactions, most commonly anger, disgust, anxiety, or a fight-or-flight response. The sounds that trigger misophonia are typically human-generated and repetitive:

• •Chewing, swallowing, lip-smacking
• •Breathing, sniffing, throat-clearing
• •Keyboard typing, pen clicking
• •Foot tapping, pen chewing

People with misophonia do not perceive these sounds as louder than normal. The problem is not volume — it is the emotional and physiological response the sound provokes. A person with misophonia may feel an overwhelming urge to leave the room, cover their ears, or confront the person making the sound.

Misophonia is not currently listed as a distinct diagnosis in the DSM-5-TR, but growing research supports it as a neurologically based condition. A 2017 study published in Current Biology by Kumar et al. found that people with misophonia show abnormal connectivity between the auditory cortex and regions of the brain involved in emotional processing (the anterior insular cortex).

Key Features of Misophonia

• •Triggers are specific: Typically repetitive, human-made sounds (eating, breathing, typing)
• •Emotional response is intense: Anger, disgust, rage, anxiety, panic — disproportionate to the sound itself
• •Fight-or-flight activation: Physiological arousal including increased heart rate, muscle tension, sweating
• •Selective: Only certain sounds trigger the reaction; the same sounds may not bother others in the room
• •Often begins in childhood or adolescence: Typically between ages 9–13
• •Not related to hearing loss: People with normal hearing can have misophonia

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What Is Hyperacusis?

Hyperacusis is a condition in which everyday sounds are perceived as abnormally loud or painful, even when others around you do not find them bothersome. Unlike misophonia, hyperacusis is about the perceived volume or physical discomfort of sound, not the emotional content.

Common triggers for hyperacusis include:

• •Running water, dishes clanking
• •Car engines, traffic noise
• •Vacuum cleaners, hair dryers
• •Alarm clocks, doorbells
• •Normal conversation volume in some cases

Hyperacusis is often associated with underlying auditory conditions. It is frequently reported alongside tinnitus (ringing in the ears), and it can develop after acoustic trauma, head injury, ear surgery, Lyme disease, Bell’s palsy, or certain neurological conditions. Some people are born with sound sensitivity (Williams syndrome and autism spectrum disorder are associated with hyperacusis).

Key Features of Hyperacusis

• •Triggers are broad: Any sound above a certain volume threshold can be problematic
• •Response is physical discomfort or pain: Ear pain, pressure, aching — not primarily emotional anger or disgust
• •Volume-based: The louder the sound, the worse the discomfort
• •Associated with auditory system dysfunction: Often co-occurs with tinnitus, hearing loss, or ear injury
• •Can develop at any age: Often follows acoustic trauma, illness, or neurological events
• •Functional impact: May lead to wearing ear protection in everyday settings, social withdrawal

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Side-by-Side Comparison

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Can You Have Both?

Yes. Some people experience both misophonia and hyperacusis simultaneously. Research suggests that approximately 40–50% of people with hyperacusis also report misophonia-like symptoms, and vice versa. When both conditions co-occur, treatment needs to address both the auditory sensitivity (hyperacusis) and the emotional reactivity (misophonia).

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How Each Is Diagnosed

Neither misophonia nor hyperacusis has a universally accepted diagnostic criteria in the DSM-5-TR or ICD-11. However, clinical assessment typically includes:

For Misophonia:

• •Detailed trigger identification (specific sounds, contexts)
• •Assessment of emotional and physiological responses
• •Audiological evaluation (to rule out hearing loss)
• •Screening for co-occurring conditions (OCD, anxiety, ADHD)
• •Use of validated questionnaires such as the Misophonia Questionnaire (MQ) or the Amsterdam Misophonia Scale (A-MISO-S)

For Hyperacusis:

• •Loudness discomfort levels (LDL) testing by an audiologist
• •Full audiological evaluation (to identify hearing loss, tinnitus)
• •Assessment of functional impact on daily life
• •Medical history review (acoustic trauma, neurological events, medications)
• •Screening for tinnitus and other auditory conditions

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Treatment Approaches

Misophonia Treatment

• •Cognitive Behavioral Therapy (CBT): The most evidence-supported treatment. CBT for misophonia focuses on changing the conditioned emotional response to trigger sounds through gradual exposure, cognitive restructuring, and coping strategy development.
• •Sound therapy: Background noise generators, white noise, or nature sounds can reduce the contrast between silence and trigger sounds, making triggers less noticeable.
• •Mindfulness and relaxation training: Techniques to manage the autonomic arousal (fight-or-flight response) triggered by sounds.
• •Tinnitus Retraining Therapy (TRT): Adapted for misophonia, TRT combines counseling with sound therapy to reduce the brain’s attention to trigger sounds.
• •Environmental modifications: Using earplugs or noise-canceling headphones in triggering situations (used as a temporary strategy, not a long-term avoidance solution).
• •Medication: No medication is FDA-approved for misophonia. Some clinicians prescribe SSRIs or anti-anxiety medications for co-occurring anxiety or OCD, but these do not treat misophonia directly.

Hyperacusis Treatment

• •Sound desensitization therapy: Gradual, controlled exposure to increasing sound levels over weeks to months, guided by an audiologist. The goal is to recalibrate the auditory system’s tolerance.
• •Tinnitus Retraining Therapy (TRT): Often used when hyperacusis co-occurs with tinnitus. Combines counseling with broadband sound generators.
• •Cognitive Behavioral Therapy (CBT): Helps manage the anxiety and avoidance behaviors that develop around sound sensitivity.
• •Hearing protection management: Avoiding overuse of ear protection (which can worsen hyperacusis by further sensitizing the auditory system). An audiologist can guide appropriate protection use.
• •Medical treatment of underlying conditions: If hyperacusis is secondary to an ear injury, Lyme disease, or neurological condition, treating the underlying cause may improve symptoms.

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When to See a Professional

Seek professional evaluation if:

• •Sound sensitivity is causing significant distress or impairment in work, school, or relationships
• •You are avoiding social situations, restaurants, or family meals due to sound triggers
• •You experience ear pain or physical discomfort from normal everyday sounds
• •Sound sensitivity developed suddenly after an acoustic event, head injury, or illness
• •You are using ear protection excessively or withdrawing from daily activities

An audiologist can evaluate hearing and assess loudness discomfort levels. A psychologist or therapist experienced with CBT can help manage emotional responses. For misophonia specifically, the Misophonia Association (misophonia.com) and the International Misophonia Research Network maintain directories of informed providers.

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Sources

• •Kumar, S. et al. (2017). “The brain basis for misophonia.” Current Biology, 27(4), 527–533.
• •Jastreboff, M.M. & Jastreboff, P.J. (2001). “Hyperacusis and Retraining Therapy.” ENT Journal, 80(11).
• •Brout, J.J. et al. (2018). “Investigating misophonia: A review of the empirical literature, clinical implications, and a research directive.” PeerJ, 6, e5664.
• •Aazh, H. et al. (2014). “Hyperacusis: prevalence, clinical features, and associated conditions.” American Journal of Audiology, 23(3), 301–308.
• •American Speech-Language-Hearing Association (ASHA) — Hyperacusis resources.
• •Misophonia International Research Network — misophonia-research.com.