Misophonia Patterns in Hyperacusis and Normal Hearing

A new study of 153 young adults with normal hearing finds that 31.4% met the objective audiological criteria for hyperacusis, defined by an Uncomfortable Loudness Level (ULLmin) of 77 dB HL or lower. Among those with confirmed hyperacusis, over half (52.1%) also met the screening threshold for misophonia. The research suggests hyperacusis is the strongest predictor of misophonia symptoms, highlighting significant overlap between these forms of decreased sound tolerance.

How Researchers Separated Hyperacusis from General Sound Sensitivity

A team led by Ahmad Rasouli and Vida Rahimi from Tehran University of Medical Sciences, with co-author H. Aazh from London, designed a cross-sectional study to clarify the relationship between hyperacusis and misophonia. They recruited 153 participants aged 19 to 31 with normal hearing and self-reported sensitivity to environmental sounds, but without tinnitus, via social media.

The study’s design was clear. First, participants were objectively classified into two groups based on a key audiological measure: the Uncomfortable Loudness Level minimum (ULLmin). Those with a ULLmin of 77 dB HL or lower were placed in the hyperacusis group. Those with a ULLmin above 77 dB HL were in the non-hyperacusis group. This objective measure separated physical loudness tolerance from subjective feelings of sensitivity.

To identify misophonia, researchers used two psychometric tools. They applied thresholds from the Sound Sensitivity Symptoms Questionnaire (item 4 score ≥2) and the Misophonia Questionnaire-Misophonia Severity Scale (score ≥7). Audiological testing also examined ULL slope (how quickly discomfort increases with volume), asymmetry between ears, and differences upon repeated testing.

Key Findings: A Strong Link Between Hyperacusis and Misophonia

The results, published in the International Journal of Audiology, provide clear distinctions. The 31.4% of participants in the hyperacusis group had significantly lower ULLmin and steeper ULL slopes than the non-hyperacusis group. As expected, they also scored higher on the Hyperacusis Questionnaire (HQ), Sound Sensitivity Symptoms Questionnaire (SSSQ), and Misophonia Questionnaire (MQ).

The prevalence of misophonia symptoms was striking. More than half (52.1%) of the hyperacusis group met the screening criteria for misophonia. In the non-hyperacusis group—those who reported sensitivity but had normal objective loudness tolerance—the rate was 32.4%. This difference was statistically significant (p=0.020).

Multivariable analysis confirmed the central finding. Hyperacusis status itself emerged as the strongest independent predictor of having misophonia symptoms. Specific ULL characteristics, including the ULLmin value and the steepness of the ULL slope, also contributed to the model. This indicates that the physical auditory system’s response to volume is directly related to the presence of misophonia.

Not All Sound Sensitivity is Hyperacusis

A critical implication of this study is that a majority (68.6%) of the young adults who reported being sensitive to sounds did not meet the objective audiological criteria for hyperacusis. Their ULLmin was above 77 dB HL. This confirms that the subjective experience of sound sensitivity or annoyance is a broader category that includes, but is not limited to, hyperacusis.

This distinction is important for both patients and clinicians. It means someone can be highly bothered by specific sounds (potentially misophonia) without having a reduced tolerance for loudness across all sounds (hyperacusis). Our existing article, “Misophonia vs Hyperacusis: Sound Sensitivity Patterns”, explores these clinical differences in detail.

The study also validates the use of objective measures like ULLmin in clinical assessment. Relying solely on self-report can blur the lines between different conditions, potentially leading to less targeted management strategies.

Practical Implications for Assessment and Future Research

For clinicians, these findings support a two-pronged assessment approach for patients presenting with sound sensitivity. An integrated evaluation should include both standard audiological testing (especially ULL measures) and psychometric questionnaires for conditions like misophonia. This combination can help differentiate hyperacusis, misophonia, or a combination of both, which appears common.

The substantial overlap in symptoms and audiological correlates suggests these conditions may share underlying neural mechanisms. As lead author Rasouli and colleagues note, this highlights “the need for longitudinal and neuroimaging studies” to understand the common pathways. Understanding shared mechanisms could inform more effective treatments that address root causes rather than just symptoms.

For individuals struggling with sound sensitivity, this research reinforces that their experience is measurable and real. It also clarifies that different types of sensitivity exist, which can guide them toward more specific resources and management approaches, such as the counseling methods often used for related auditory disorders.

Conclusion: A Step Toward Clearer Diagnosis

The work by Rasouli, Rahimi, Fatahi, Zaree, and Aazh provides valuable data for a complex clinical area. By objectively classifying hyperacusis and screening for misophonia in the same cohort, they demonstrate a clear predictive link. Hyperacusis is the strongest indicator for the presence of misophonia symptoms, and many individuals have both conditions.

This study moves the field toward more precise definitions. It confirms that while hyperacusis and misophonia are distinct for many, they co-occur frequently and share audiological features. This evidence supports comprehensive, multi-method assessment as the best practice for anyone reporting decreased sound tolerance. Future research, particularly brain imaging studies, is now needed to explore the neural overlap these findings suggest.

Source: Rasouli A, Rahimi V, Fatahi F, et al. A comparison of misophonia proportion and patterns of uncomfortable loudness levels between individuals with and without hyperacusis reporting sensitivity to environmental sounds. Int J Audiol. 2026;1-12. doi:10.1080/14992027.2026.2642751. PMID: 42057697.