Why Sounds Can Trigger Strong Emotional Reactions: Understanding Hyperacusis and Misophonia

Many people with tinnitus also notice problems with sound tolerance. Some sounds feel physically uncomfortable or painfully loud, while others trigger intense emotional reactions such as anger, anxiety, or distress. A well-known theoretical paper helps explain why these reactions happen in the brain, and why hyperacusis and misophonia are related but different.

In 2025, Pawel J. Jastreboff and Margaret Jastreboff revisited and expanded their neurophysiological model describing tinnitus, hyperacusis, and misophonia.

One brain, different sound responses

According to this model, it is possible to experience tinnitus, hyperacusis, and misophonia separately or in combination. Although they feel different, they involve overlapping brain systems rather than damage to the ears alone.

The model focuses on how sound signals interact with emotional, autonomic, and attention systems in the brain, often outside conscious awareness.

How hyperacusis is explained

In hyperacusis, the model proposes that the brain’s sound-processing pathways become over-amplified. This means that sounds reaching the brain produce a much stronger response than they should, even when the sound itself is moderate.

As a result:

• Ordinary sounds feel excessively loud or uncomfortable
• The nervous system reacts as if the sound were much stronger
• Emotional and physical stress responses can be triggered automatically

This helps explain why people with hyperacusis often feel overwhelmed by everyday sounds, even when hearing tests appear normal.

How misophonia is explained

In misophonia, sound loudness is usually normal. Instead, the model suggests that specific sound patterns become strongly linked to emotional and bodily responses through learned, subconscious connections.

In this view:

• Certain sounds become powerful triggers
• Reactions happen automatically and very quickly
• The response is emotional rather than driven by loudness
• The reaction can feel out of proportion and hard to control

Importantly, these connections are thought to form through learning and conditioning rather than conscious choice.

Why hyperacusis and misophonia can look similar

The model explains why reactions in hyperacusis and misophonia can appear very similar from the outside. In both cases, the body may show anxiety, tension, anger, or a strong urge to escape.

However, the underlying mechanisms are different, which is why the authors argue that hyperacusis and misophonia require different approaches to assessment and treatment.

What this means for patients

This model supports several important and reassuring points:

• Strong reactions to sound are brain-based, not imagined
• These reactions occur automatically, not by choice
• Hyperacusis and misophonia are distinct, even if they overlap
• Treatment should be tailored to the specific pattern of sound intolerance

It also helps explain why simply “getting used to the sound” or forcing exposure rarely works without the right structure and support.

Implications for care

Although this paper presents a theoretical model rather than treatment trials, it has influenced how clinicians think about sound intolerance. It supports approaches that:

• Distinguish between loudness-based and trigger-based sound problems
• Address emotional and threat responses linked to sound
• Use gradual, structured retraining rather than avoidance or force
• Focus on nervous system learning rather than ear damage

At Hashir Tinnitus Clinic, we draw on a range of models and research findings to guide personalised assessment and care, recognising that different sound sensitivities need different strategies.

Learn more

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

Jastreboff, P. J., & Jastreboff, M. M. (2025). The neurophysiological model for hyperacusis and misophonia. Journal of Hearing Science.
https://doi.org/10.17430/jhs/211238

If you are experiencing tinnitus, hyperacusis, or misophonia and would like help understanding what may be driving your reactions to sound, we are always happy to explore this with you during an appointment.