Why Misophonia and Hyperacusis Need Different Treatments

People with sound sensitivity often describe very similar experiences: distress, discomfort, or strong reactions to everyday sounds. This can make conditions like hyperacusis and misophonia hard to tell apart. A recent hypothesis paper explains why these conditions may look similar on the surface but require different approaches to diagnosis and treatment.

In 2025, Margaret M. Jastreboff and Pawel J. Jastreboff outlined how misophonia and hyperacusis differ within the brain, and why recognising these differences matters for effective care.

Similar symptoms, different mechanisms

The paper highlights that people with hyperacusis and misophonia often report very similar reactions, including anxiety, irritation, avoidance, and physical tension. Because of this overlap, the two conditions are sometimes grouped together or treated in the same way.

However, the authors argue that the underlying mechanisms are different, even when reactions appear identical.

• In hyperacusis, the brain is thought to amplify sound signals too strongly, making ordinary sounds feel excessively loud or uncomfortable.
• In misophonia, sound loudness is usually normal, but specific sound patterns become strongly linked to emotional and bodily reactions through learning and conditioning.

This distinction helps explain why the same treatment does not work equally well for everyone.

Why assessment needs more than hearing tests

The paper emphasises that hearing tests alone cannot reliably distinguish between hyperacusis and misophonia. Audiological measures are useful, but they do not capture emotional, behavioural, and trigger-specific responses to sound.

Instead, a detailed clinical interview is essential. Understanding which sounds trigger distress, how reactions develop, and what meaning the sound has for the person helps guide the right treatment approach.

Different conditions, different treatment goals

According to the model described in the paper:

• Treatment for hyperacusis focuses on gradually reducing the brain’s over-amplification of sound. This involves carefully structured sound exposure and counselling aimed at helping the auditory system become less reactive over time.
• Treatment for misophonia focuses on weakening the learned emotional reactions to specific trigger sounds. This involves working with conditioned responses rather than sound loudness itself.

Although both approaches may include education and sound-based strategies, the purpose and structure of treatment are different.

Why the distinction matters for patients

This framework helps explain why some people feel frustrated after trying treatments that did not help. If the underlying mechanism is misidentified, even well-designed therapy may feel ineffective.

The key messages for patients are:

• Strong reactions to sound are brain-based and automatic
• Similar symptoms can arise from different mechanisms
• Treatment works best when matched to the specific pattern of sound intolerance
• Lack of improvement does not mean the problem is untreatable

Interpreting treatment outcomes carefully

The authors report high rates of clinical improvement when treatment is matched to diagnosis within their model. It is important to understand that this paper presents a hypothesis-based framework rather than results from large independent trials.

Nonetheless, the model has influenced clinical thinking by reinforcing the importance of differential diagnosis, individualised care, and realistic treatment goals.

What this means for care at the clinic

At Hashir Tinnitus Clinic, we recognise that misophonia and hyperacusis require different assessment pathways and support strategies. Treatment is guided by careful listening to each person’s experience, rather than assuming all sound sensitivity is the same.

Understanding the pattern behind your reactions helps determine whether the focus should be on sound tolerance, emotional responses, or a combination of both.

Learn more

If you would like to read the original hypothesis paper, it is available here:

Jastreboff, M. M., & Jastreboff, P. J. (2025). Diagnosis and treatment of misophonia and hyperacusis based on the neurophysiological model. Journal of Hearing Science.
https://doi.org/10.17430/jhs/211342

If you are unsure whether your symptoms fit hyperacusis, misophonia, or a combination of sound sensitivities, we are always happy to explore this with you during an appointment.