Misophonia and Hyperacusis: Sound Sensitivity Study

A study of 153 young adults reporting sensitivity to everyday sounds reveals a key distinction: only one-third objectively had hyperacusis. The group with confirmed hyperacusis had a significantly higher rate of misophonia symptoms.

Objective Hyperacusis and Self-Reported Sensitivity Often Differ

The research team from Tehran University of Medical Sciences and Hashir International Specialist Clinics recruited 153 participants aged 19 to 31 via social media. All reported being sensitive to environmental sounds but did not have tinnitus. They were then classified based on an objective audiological measure: the lowest sound level at which any frequency became uncomfortable, known as ULLmin.

Using a standard diagnostic threshold (ULLmin ≤77 dB HL), 31.4% of the sample met the criterion for hyperacusis. The majority—68.6%—did not, despite their self-reported sensitivity. This finding, led by Ahmad Rasouli and colleagues, highlights that the experience of sound intolerance is complex and not always captured by a single test.

How Hyperacusis and Misophonia Symptoms Overlap

The study used two screening tools to identify symptoms of misophonia: a specific question from the Sound Sensitivity Symptoms Questionnaire (SSSQ) and the Misophonia Severity Scale from the Misophonia Questionnaire.

The results showed a clear pattern. The group with objective hyperacusis had significantly lower ULLmin scores, steeper slopes of uncomfortable loudness levels across frequencies, and higher scores on hyperacusis and misophonia questionnaires. Most notably, misophonia symptoms were substantially more prevalent in this group. 52.1% of the hyperacusis group screened positive for misophonia, compared to 32.4% in the non-hyperacusis group (p=0.020).

This aligns with other research exploring the brain responses to sounds in misophonia vs. hyperacusis, suggesting shared but distinct neural pathways.

Hyperacusis Status is the Strongest Predictor of Misophonia

To understand what drives the presence of misophonia symptoms, the researchers conducted a multivariable analysis. They found that the strongest independent predictor was simply whether a person had objective hyperacusis.

Audiological characteristics also contributed. A lower ULLmin (greater loudness discomfort) and a steeper ULL slope (where discomfort increases sharply with small increases in volume) were significant factors. This statistical model reinforces the idea that the physiological response to sound intensity (hyperacusis) is closely linked to the emotional and aversive response to specific sound patterns (misophonia symptoms).

Implications for Assessment and Future Research

The study has direct practical implications for clinicians. It argues for an integrated assessment protocol. For any patient presenting with sound sensitivity, evaluation should include both objective audiological measures, like ULLs, and psychometric questionnaires for conditions like misophonia and hyperacusis. This dual approach can better characterize the individual’s experience and guide management strategies.

The authors note that many sound-sensitive individuals did not meet the hyperacusis threshold. This group may include people with primary misophonia, where the reaction is more tied to the context or meaning of a sound rather than its volume alone. Accurate differentiation is essential for targeted treatment, which could include approaches like tinnitus management counseling techniques adapted for misophonia, or emerging digital therapeutic apps designed for chronic auditory conditions.

The paper concludes by calling for longitudinal studies to see how these conditions develop over time, and for neuroimaging studies to clarify the underlying brain mechanisms. Understanding these overlaps is a necessary step toward developing more effective interventions for decreased sound tolerance.

The full study, “A comparison of misophonia proportion and patterns of uncomfortable loudness levels between individuals with and without hyperacusis reporting sensitivity to environmental sounds,” is available online ahead of print in the International Journal of Audiology (DOI: 10.1080/14992027.2026.2642751).