Download misophonia provider network summer 2011

MISOPHONIA PROVIDER NETWORK SUMMER 2011
www.misophonia-provider.com
Thank you for visiting our brand new provider network site. We strive to directo
those who suffer from misophonia (aka Selective Sound Sensitivity Syndrome or
4S) to regional centers where professionals will offer assessment, treatment
programs and monitoring.
This list can be located at:
http://www.misophonia-provider.com/PROVIDERS_BY_REGION.html
This letter is a resource for your use and will provide you with information on how
to contact the nearest regional clinic.
What is Misophonia?
Dr. Pawel Jastreboff’s definition:
Misophonia - abnormally strong negative reactions of the autonomic and limbic
systems to specific sounds resulting from enhanced functional connections
between the auditory and limbic systems for these sounds. The auditory system
works in a normal manner, without abnormally high activation. At the behavioral
level, sounds specific for a given patient evoke strong negative reactions. This
situation may cause general negative attitude to sound as well. When fear is
dominant emotion (patient is afraid of sound) phonophobia occurs (phobia - fear).
Phonophobia is a specific case of misophonia.
Definition from the UK’s Misophonia Site:
misophonia
Fear or hatred of certain (or all) sounds. A term coined by US scientists Pawel and
Margaret Jastreboff in 2001. Misophonia, SSSS, phonophobia and hyperacusis are
often used interchangeably which is not helpful to definitional clarity. Misophonia
UK's position is that:
● misophonia should be used to refer to a dislike of some, or all, sounds. Two
apparently distinct kinds of misophonia are loud sound misophonia (LSM) and soft
sound misophonia (SSM), better known as selective sound sensitivity sydrome or
4S.
● selective sound sensitivity should be considered a type of misophonia, where
soft sounds (typically eating and breathing sounds made by emotional attachment
figures) are the focus, and the quality of those sounds causes annoyance and rage
in the listener.
MEDICAL DICTIONARY DEFINITION
misophonia
Type: Term
Pronunciation: mis-ō-fō′nē-ă
Definitions:
1. Dislike of sound.
Dr. Johnson, AuD Site www.hyperacusis.org :
Misophonia: Dis-Like of Sounds, finding sound itself or particular sounds,
aggravating or overwhelming, a feeling of sensory overload or over-stimulation,
this can lead to self-isolation, removal from noisy environments, using earplugs
often, withdrawing from work or social situations, avoiding sounds or noises.
Selective Soft Sound Sensitivity (4S): A variant of misophonia that includes only
very soft particular noises, called Trigger Sounds, most often sounds associated
with oral functions such as chewing, lip licking, smacking, or breathing
MECHANISMS OF MISOPHONIA: THEORIES
Dr. Hazell: (website on hyperacusis and misophonia)
Hyperacusis is due to an alteration in the central processing of sound in the
auditory pathways where there is an abnormally strong reaction from exposure to
moderate sound levels. The cochlea is often completely normal, although patients
frequently wrongly believe it is irreversibly damaged. Traditional teaching
involved only an understanding of 'recruitment' , the result of cochlea damage.
Since all people with hyperacusis can be helped by a behavioural approach with
'sound' therapy, it has become clear that the symptoms cannot be the result of
irreversible ear damage. Another reason for sound sensitivity is misophonia. This
means a dislike of being exposed to a certain sound. Here the auditory pathways
may be functioning normally, but there is an abnormally strong reaction of the
limbic (emotional system) and autonomic nervous system (body control system)
to which the auditory system is intimately connected.
Drs. Hughes and Pensak (Clinical Otology Textbook) 2007
Misophonia can be considered abnormally strong connections between the
autonomic and limbic resulting from enhanced connections between the auditory
and limbic systems. These connections encompass both a high level of cortical
level loop with involvement with cognition as well as subconscious connections,
most probably involving the link between the medial geniculate body and the
amygdale. The functions of these connections are governed by the principles of
conditioned reflexes.
WHY DOES MISOPHONIA AFFECT US SO STRONGLY?
Dr. Hazell:
The process of developing an increased sensitivity to specific sound always
involves the limbic system and autonomic nervous system. Where phonophobia
or misophonia exists there is an inevitable association of fear or dislike,
associated with the appearance of the sound, whenever it occurs. The attentional
focus becomes filled with that sound, so that interference with concentration (on
another task) occurs. These conditioned responses act like survival reflexes and
have to carry a message of unpleasant emotion, in order to ensure that a
response occurs. They also stimulate the autonomic nervous system to prepare us
for 'flight or fight' so there may be coincident increases in heart rate, sweating,
muscle tension, and other adrenaline-mediated body responses
WHAT ARE THE MOST TYPICAL RESPONSES: (Johnson, survey 2009)




Anger, rage, irritation, annoyance
Anxiety, urge to flee, escape environment (flight)
Depression, self-hatred, shame, negative self image, emotional
Need to strike back, physically or using mimicking sounds or noises
WHAT IS THE MOST COMMON AGE OF ONSET: *Johnson, surveys 2004, 2009
Pre puberty seems to be a very common age of onset for the majority of
those with misophonia, with lifetime persistence for most cases, and there
appears to be a genetic component
WHAT MEDICAL PROVIDERS MIGHT BE SEEN FOR MISOPHONIA?
1.
2.
3.
4.
Primary care MDs, to rule out any other diseases or illness
Ear Nose & Throat Physician, to examine auditory system
Audiologist, to examine auditory system, evaluate treatment
Psychologist, to examine for phobias, emotional or mental health issues,
set up a cognitive behavioral therapy approach as part of a team, address
other issues as they arise, provide mindfulness or other therapies
5. Psychiatrist, to evaluate use of bio-chemicals for other conditions related to
psychiatric findings, assessments for other issues
6. Counselors, to provide ongoing support and therapy for sufferer and family
7. Alternative healthcare providers to assist with a variety of healthful or
health promoting treatments or therapies
WHAT MIGHT BE INCLUDED IN A MISOPHONIA ASSESSMENT?
 General physical, bloodwork to rule out any problems
 Detailed case history by every provider
 Most will visit ENT, and audiologist, these visits can include visual
inspection of ear canals, assessment of the auditory system including a
hearing test using air and bone conduction, tympanometry to examine
middle ear function, speech tests to examine processing of language
sounds, loudness discomfort level (LDL) tests using voice, tones, noise or
other sounds. The new Misophonia Assessment Questionnaire (MAQ)
should be completed by the patient or a parent
 Interview with Psychologist or Counselor using a variety of assessment
tools to define condition and symptoms.
 Trials of various medications is commonly included for misophonics which
may include anti anxiety, anti OCD, mood elevators or sleep medications
WHAT ARE TREATMENTS FOR MISOPHONIA?
 Tinnitus retraining therapy has been tried using bilateral sound
generators and directive counseling
 Earplugs are often prescribed to help block out intruding sounds
 Cognitive therapy
 Desensitization therapies including adversive exposure therapy, sensory
integration auditory programs, and many others
 Counseling therapies
 Rotating cycles of pleasant sound therapy paired with unpleasant
sounds
 Psychoanalysis
IS THERE A GOLD STANDARD TREATMENT FOR MISOPHONIA?
No. We are working on developing such a protocol. Right now we have
two possible programs, one that uses audiologists as the primary service
providers and using a new sound therapy, and a second approach that
combines psychological counseling (CBT) with the use of pleasant sound
stimuli.
IS THERE A CURE?
Sadly, no. Perhaps one day there will be one.
WHAT TO DO NEXT:
Contact a regional center and arrange for a full misophonia evaluation.
The qualified providers will assist you in discovering what can be done to
improve your situation.
Thank you for contacting our network website
CURENT LIST OF PROVIDERS:
REGION: NW, W Coast USA
Dr. Marsha A. Johnson, Audiologist
Oregon Tinnitus & Hyperacusis Treatment Clinic, est 1997
825 NE 20th Suite 230
Portland, OR 97232
503 234 1221
fax 503 234 4227
website: www.tinnitus-audiology.com
email: [email protected]
MID WEST
Paula Schwartz, Au.D.
Doctor of Audiology
Audiology Concepts, Inc.
6444 Xerxes Ave. South
Edina, MN 55423
www.audiologyconcepts.com
Tinnitus and Hyperacusis Clinic
6446 Xerxes AVe. South
Edina, MN 55423
www.tinnitusclinicminnesota.com
952-831-4222 fax 952-831-4942
Jill B. Meltzer, Au.D.
North Shore Audio-Vestibular Lab
1160 Park Avenue West, Suite 4 South
Highland Park, IL 60035
phone: 847.432.5555
fax: 847.432.5554
www.nsavl.com
office email: [email protected]
email contact: [email protected]
Diane Duddy, AuD
Audiologist
Division of Adult Audiology
Washington University School of Medicine
Campus Box 8115
660 S. Euclid
St.Louis, MO 63110
(314)362-7489
http://audiology.wustl.edu
NEW ENGLAND
Natan Bauman, Ed.D., M.S. Eng
New England Tinnitus and Hyperacusis Clinic
2661 Dixwell Avenue
Hamden, CT 06518
203-287-9915
www.hearingbalance.com
EAST COAST USA
Dhyan Cassie, AuD
Tinnitus/Hyperacusis Treatment Center
Ear, Nose & Throat Professionals
209 Taunton Road
MEDFORD, NJ 080553419
Phone: (856)983-8981