The Spectre of Treating Misophonia

Of all the conditions I’ve worked with—auditory processing disorder, hyperacusis (excluding phonophobia), tinnitus, and hearing loss—misophonia may be the most devastating. It has a unique power to unravel families and lives from the inside out.

Misophonia doesn’t just annoy. It teaches rage, disgust, isolation, and fear. It creeps in silently and rewires the nervous system until survival instinct kicks in from something as small as a sound. I was never taught about it in the 1990s as a student, nor did I encounter it in traditional ENT clinics—until one day, I met a boy who had spent an entire year isolated from school, sitting in a hallway to avoid harming his classmates. He hallucinated his auditory triggers, even when I used low-gain hearing aids to try masking them. Eventually, I had to refer him to psychiatry.

As a clinician with personal experience in sensory processing challenges, anxiety, and depression—and someone who takes medication—I knew this child was outside the scope of what I could manage alone. I suspected he might have been suicidal. Even now, I wouldn’t work with someone in that condition without a full, collaborative team.

Misophonia is terrifying. It blends obsessive-compulsive thinking, anxiety, impulsivity, self-isolation, rigidity, guilt, and egocentrism. And perhaps most terrifying—it sometimes appears fully formed, out of nowhere.

I still love working with auditory processing and hearing loss, but I’ve grown more confident and efficient in those areas. Misophonia, on the other hand, draws me in because of its complexity. I understand it—not just clinically, but emotionally. These “lost” kids and adults remind me of myself.

Thanks to my background in APD, I’ve learned how to work effectively in real-time, in real environments. Using internet-based tools, I can filter and adjust auditory input as it happens. And I’ve been surprised by how much progress I’ve seen. The four children and teens currently in my trial program—and many ongoing patients—have all recently reported improvement.

But misophonia is capricious. Gains come and go. This is not a standard hearing loss—it’s a dysfunctional sound-limbic system connection. A fight-or-flight loop. A wound buried in the nervous system.

And I’m not a therapist. I’m an audiologist. There’s no couch in my office. I listen, and I troubleshoot using tools and strategies. That’s my role. But after decades of working with more straightforward cases, I find this work harder—and more rewarding.

I’ve always been a seeker. The child who struggled with focus, who was distracted by shiny things and squirrels. I became the audiologist who brought stereo equipment and old movies into sterile clinics, simulated noisy restaurants, tested kids in background noise (permission or not), and frustrated more than one boss. I needed stimulation. My patients did too.

Now that I work independently, I’ve built a model that lets me collaborate meaningfully with families. This is what misophonia demands: problem-solving with flexibility and creativity. I’ve recently begun partnering with Deaf educators on the concept of intentional selective hearing—offering children the option to not hear, without being cut off from communication. I’ve also collaborated with occupational therapists on using alternate sensory inputs to reduce trigger contrast, and with special educators and psychologists to design more functional accommodations.

There is no cookie-cutter model for misophonia. And I have no illusions about my own limitations. I’m not an expert. I’m someone who listens, who experiments, who learns through failure, and who adapts.

Misophonia doesn’t respond to simple solutions. It requires layered, patient, cooperative care. My low-gain hearing aids help, but only as part of a much larger effort. These devices are not magic—they’re tools. And like any tool, their success depends on how well they’re integrated into a bigger plan.

Every child or adult with misophonia needs a custom map. That takes trial, error, time, and more time. And all the while, the individual—and their family—feels like they’re running out of time, patience, and oxygen.

So we keep listening. We keep adjusting. We keep trying. And when we hit a wall—we ask for help.

That is the only path forward.

Visual Description:

This cartoon-style digital illustration shows a young Black boy seated alone at a wooden desk in the middle of a long, empty school hallway. His posture is slouched, one elbow resting on the desk, his head leaning against his hand. His expression is one of deep distress, distraction, or anxiety. The hallway is lined with closed and partially open classroom doors, receding into the distance. From several of the doors, visual sound waves—suggested by wavy lines—spill into the hallway, indicating the noise filtering out from classrooms. The lighting is warm but muted, emphasizing the boy’s isolation despite the setting being part of a school environment.

Why This Picture Was Chosen:

This image represents the reality that many children with misophonia or severe sensory sensitivities face: being physically removed from their learning environment in an attempt to “manage” their behaviors. It visualizes what’s often hidden—the emotional and cognitive overload caused by sound triggers, and how this can lead to self-isolation, academic disengagement, and social exclusion.

This boy isn’t simply distracted—he’s hypervigilant. He’s listening not to learn, but to brace himself for the next sound that might push him over the edge. The setting illustrates that, even when separated from peers for safety, the sensory threat is still very present. This is what untreated or unsupported misophonia can look like: a child alone, overwhelmed, trying to survive a school day one sound at a time.

I chose this picture to give a face and a setting to something that is often misunderstood. It’s not just “sensitivity.” It’s a breakdown in how the brain interprets sound—and it deserves real, compassionate solutions.

References:

Cowan, E. N., Marks, D. R., & Pinto, A. (2022). Misophonia: A psychological model and proposed treatment. Journal of Obsessive-Compulsive and Related Disorders, 32, 100691.  

Schröder, A., Vulink, N., & Denys, D. (2013). Misophonia: Diagnostic criteria for a new psychiatric disorder. PLOS ONE, 8(1), e54706. 

Daniels, E. C., Rodriguez, A., & Zabelina, D. L. (2020). Severity of misophonia symptoms is associated with worse cognitive control when exposed to misophonia trigger sounds. PLoS ONE, 15(1).

Kumar, S., Tansley-Hancock, O., Sedley, W., Winston, J. S., Callaghan, M. F., Allen, M., & Griffiths, T. D. (2017). The brain basis for misophonia. Current Biology, 27(4), 527–533.e2.

Rouw, R., & Erfanian, M. (2018). A large-scale study of misophonia. Journal of Clinical Psychology, 74(3), 453–479.