By Randall Bartlett, Tinnitus Audiologist and Clinical Director


Misophonia is a rare and poorly-understood condition, sometimes called soft sound sensitivity syndrome, or 4S. It is characterized by a strong negative reaction to particular sounds, called triggers. These are usually, but not always, associated with mouth and body sounds being produced by particular people and in certain situations. Patients with misophonia can often tolerate high levels of similar sounds produced by non-trigger people, and similar environmental sounds produced in non-trigger situations. Triggers can also be visual or associated with certain environmental settings, thoughts, or senses, such as smell or touch. Often, triggers can have an anticipatory or apprehension stage, which occurs before a trigger sound is experienced.

Misophonia was coined by neuroscientist Dr. Pawel Jastreboff, whom I directly trained under, as part of his updated published research on Tinnitus Retraining Therapy (TRT). Previously, misophonia had NOT been identified as a distinct condition in medical, audiological or psychological literature. Dr. Jastreboff was the first to treat the disorder.


Misophonia usually occurs in childhood, but can also occur in adulthood. It typically begins with a sudden onset after some emotionally significant event associated with exposure to a first trigger sound, activating a strong emotional and behavioral reaction. Misophonia also occurs as a secondary symptom accompanying tinnitus or hyperacusis, usually associated with a condition of hearing loss, auditory damage or head trauma.


Typical triggers include mouth noises, such as eating, chewing, breathing, lip smacking, licking, whistling, or the sound of certain speech sounds. Most often, reactions begin in response only to particular individuals, usually parents or siblings. Sometimes non-speech sounds are also problematic. Examples include pen clicking, rustling paper and keyboard sounds.

Conditions that May Coincide with Misophonia

Decreased sound tolerance must be considered in the context of overall health status and may be a symptom of a variety of medical and psychological problems. Some of these include tinnitus, hyperacusis, hearing loss, family relation problems, depression, anxiety, autism or brain injury. Because multiple forms of decreased sound tolerance may be involved simultaneously, we carefully consider evaluating all conditions, especially hyperacusis.

Diagnostic Assessment

The most effective treatment almost always follows an accurate evidence-based medical, audiological and psychological diagnosis. We begin with a comprehensive hearing test battery especially formulated for misophonia. An essential feature of Misophonia assessment is a detailed clinical interview to differentiate between the types of sound and non-sound triggers that are being reacted to, and the types of reactions. The interview will also determine whether reactions are multi-sensory in nature, involve non-auditory anticipation and visual triggers, and if family relationships are being affected. Assessments are always followed by a consultation with the patient.


Our office, as well as most other pioneers who treat misophonia, have concluded that a multi-disciplinary treatment approach appears as the best option, and, in most cases, is essential for progress. This includes following an appropriate therapy, such as the Misophonia Management Protocol, Tinnitus Retraining Therapy for misophonia, or Reverse-Progressive Masking Therapy for misophonia. We, of course, offer all of these.

In addition to being preceded by a thorough evaluation, we provide counseling for the patient and family members to understand the condition and how it should be treated. We and our audiology and psychological colleagues, view misophonia a family affair because most triggers are experienced during family interactions. We are qualified to identify key behavioral and family relationship difficulties that may be relevant to the misophonia problem, before, during or as a result of reactions to triggers.

Contact Us

You are welcome to contact us to schedule an initial appointment for a Misophonia Assessment and Consultation, and auditory testing. To contact Tinnitus & Audiology Center of Southern California's Misophonia Coordinator, call (661) 259-1880 or E-mail us at hearasn@msn.com.