What’s the Difference Between Hyperacusis and Misophonia?

Which of these do you hate?

  • Plates clattering
  • Pens clicking
  • Motors idling
  • Ice rattling
  • Bass thumping
  • Paper crinkling
  • Coins jingling

All of them?

Diagnosis: Hyperacusis.

Say what?

Hyperacusis and misophonia are often confused. Both are sometimes lumped under the umbrella heading of “decreased sound tolerance.”

And in both cases, coping strategies are similar: Judicious use of earplugs or ear protection, and avoidance of situations that will expose you to the noise. For the Average Joe — and even for a doctor or audiologist — it’s hard to tell them apart.

But conflating hyperacusis and misophonia is akin to saying that a sprained ankle and an ingrown toenail are the same. Both involve a lower extremity and both make you limp.

Hyperacusis and misophonia are completely different conditions.

Hyperacusis is noise-induced pain, usually developing from an injury caused by excessive noise exposure. Ordinary sound is often perceived so loud as to be felt as pain. It’s often accompanied by other results of trauma — the pressure feeling called aural fullness, the ringing in the ears called tinnitus and a constant burning pain in the ear canal.

Misophonia is noise-induced rage, an instantaneous reaction, probably hard-wired and possibly inherited. It has nothing to do with the loudness or frequency of a sound, and everything to do with the meaning or context. A trigger sound, even a soft one, causes anger, rage or panic. Triggers can also be visual or olfactory.

Both are poorly understood and under-researched. To encapsulate the difference in one quick soundbite? Hyperacusics hate loud sounds; misophones hate soft sounds.

A more nuanced list of key differences between misophonia and hyperacusis


H: Often a physical injury or illness — excessive noise exposure, a blow to the head, Lyme Disease, floxie poisoning, ME/Chronic Fatigue.

M: Appears to be hard-wired and inherited.


H: Usually after acoustic overexposure, injury or illness.

M: Usually suddenly in late childhood or early adolescence.


H: Pain in the ear canal.

M: Rage, anger, panic.


H: Aural fullness or pressure, tinnitus (ringing in ears), pain in ear canal. These symptoms often are confined to the ear (though they can involve the scalp, jaw and neck). They usually manifest with a delayed reaction, with symptoms lingering for days, weeks or months.

M: Racing heart, sweaty palms, tight chest. These symptoms often involve the whole body. They usually come on instantaneously, dissipating after the trigger noise ends.


H: Results are U-shaped, usually lowest in the high/low frequencies and highest in the mid-frequencies. Threshold of loudness discomfort is usually well below 100 dB and can be 0 dB in severe cases.

M: Results mirror the shape of the audiogram curve. For someone without hearing loss, the line is straight across. Threshold of loudness discomfort is usually well above 100 dB, close to 120 dB or higher.


H: Often improves slowly over weeks, months or years; then worsens immediately with noise exposure.

M: Often stays stable or worsens over a lifetime.


H: No. Louder means additional ear pain.

M: Yes. Louder means more ability to drown out triggers. However, for some decibel does not change it one is triggered – though, it is important to note that louder does not cause more “pain”.


H: Months of lingering fullness, ringing, sensitivity and pain.

M: Depends whether or not it is a trigger

For more on hyperacusis, see hyperacusisresearch.org and facebook.com/hyperacusisresearch.


By J.C Cohen
Looking for more information on misophonia? Consider attending our workshops at Misophoniaeducation.com

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Anonymous January 22, 2019 - 12:24 am

Not at all helpful. Legislation is the only answer, as everyone is at risk.

Pamela Willis Jenkins February 22, 2019 - 4:36 pm

My ears rings occasionaly as least 3-5 times a week, That I believe is tinnitis. But I’ve had a constant hum in my head for years that is extremely distracting. Loud and even soft noises bother me – My eardrums actually vibrate and echo in my head. I’ll be putting silverware away, putting pills in a nightime container for my husband or dog – I can the neighbors chatting down the street…. Wish I spoke spanish… anyway I feel like I’m on a plane next to the engine all the time. Kinda done with it…. Started at age 9 (when I had a fever) but has gotten progressively worse in the past 20 years, am 58 now. And the MRI scan that I’ll be paying for for years; showed nothing to the neurologist. GREAT!
Very distracting and can’t concentrate 80% of the time.

Gwin DeMatteo May 19, 2019 - 4:51 am

I’ve had sound-induced rage for as long as I can remember. I was just considered “abnormal.” No one ever said this was an actual condition. Had I known, it would have saved 57 years of profound misery. This really needs to be studied more and therapies developed and in my opinion, definitely needs to be tied into depression, anxiety and even personality disorders. It destroys lives.

MARGARET Kelly June 4, 2019 - 4:45 am

I know I ha e H but think I also have some of M ….is this possible or just how I react to noise with H ?

Mijanur Rohman July 3, 2019 - 9:31 am

I am so glad you found it helpful and I really hope your noise sensitivity challenges decrease. It is cerainly not pleasant.

cathy August 4, 2019 - 7:00 pm

I spent years in a high school marching band with loud sounds everyday. It wasn’t until about ten yrs ago, I started having issues with bass frequencies. It causes rage. It doesn’t hurt. But, I feel like I’m living under a gym where they’re always dribbling balls or I’m listening to King Kong’s pulse through a giant stethoscope. My office staff at my apartment get so tired of me complaining. The young man over me constantly listens to boomboomboomboom. They’ve told him to turn it down and he even said he has earplugs, but he doesn’t use them. It’s not the volume, it’s the frequency. Right now, I’m wearing ear plugs and though the volume is down, I can hear the bass with the earplugs in. It does trigger meltdowns with my high functioning autism. I can’t figure out why anyone has to listen to that all day and night. If I don’t lead my homelife to the beat of his cadence, it messes up my day. Many times, I just sit in the quiet apartment waiting for him to go somewhere so I can get some work done. I don’t like getting angry. He’s a nice guy. I just get angry and scream out during meltdowns. When I do, he hears me through the air vents and stops for a few minutes, then starts back again. I want to stand at his door while he’s sleeping and constantly hit the same cadence knocking on his door to let him know what it’s like. Hours and hours of the same boom boom boom boom. It’s good to know there’s a name for it. I wish I could afford the same earphones that jackhammer users have to wear. But, I can’t afford that. It doesn’t hurt other than an excruciating headache. But, boy does it trigger meltdowns, loud, frustrating, embarrassing meltdowns.

Gwin DeMatteo August 4, 2019 - 7:45 pm

It sucks to be us, doesn’t it? Nobody ever a through my entire 57 years of life understood how truly horrible this is to us. Like you, I’m glad to find it finally has a name. But more than half a century of suffering and many relationships lost! For me, bass is the WORST! There is no way to tune out the vibration-no headphone, no noise cancellation, no white or brown or pink noise. I have almost a Tourette’s reaction to it. The way you describe the feeling is dead on! I have tried using DBT skills and sometimes can manage to keep the rage under control, realizing the sound is transitory. Thankfully, I live in my own home now in a 55 and older community and no longer have to be subjected to the constant “dribbling of basketballs” above my head. I often cry thinking how wonderful life could have been if only I had been more “normal”.

Sally October 27, 2019 - 8:28 pm

Try tubes it Helped me!

Gwin October 27, 2019 - 10:19 pm

What sort of tubes? Please explain.

Patricia H August 18, 2019 - 3:46 pm

I am a high school teacher. The number one sound is SNIFFLING. I have flung entire boxes of Kleenex at kids. Clicking pens, young people that just bounce a basketball because it is in their hands (doesn’t bother me if it is in a game). People in a theatre that talk or whisper constantly, or those that are trying to open a piece of candy or bag of chips QUIETLY. I just want to rip it out of their hands, open it in one blow and return it to them. Plus those that have to repeatedly reach into that bag for chips or candy… the crunching of the bag makes me want to hit them. . Kids playing video games or music and the sound is barely audible (but to me…AAAARRRGHH),

So, first day of class with new kids, a Power Point of what MISOPHONIA IS and my personal triggers. I have no foot tapping or knuckle crunching. Still have the sniffles, but all I have to do is say is “Who has the nose problem?”. They get up, grab Kleenex, and go into the hall. I feel your pain people. I have a very hard time traveling in an airplane, with babies whining or crying (this is hit and miss), people and video games, kids (period), and repetitive sounds. And in the summer I travel a LOT. Almost always an unpleasant situation. I grab my cell and play Mahjong or do puzzles to try to not hear it.

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