Slurping, Snuffling, and Crunching: Assessing Misophonia Symptoms

Do you find the sound of people chewing unbearably annoying? Or perhaps you can't stand to be near folks who are typing on noisy keyboards, fidgeting with their pens, or rustling a plastic bag of chips. The term for this sort of aversion is misophonia. Even if you don't personally deal with this issue, you may know someone who does. In this episode, we talk with Benjamin Kirby (Wichita State University) and Olivia Zant (University of North Texas), whose recent JASA Express Letters article, “Psychoacoustic Assessment of Misophonia,” touches on this topic.

Associated paper: Benjamin J. Kirby, Alaina Cunningham, and Olivia Montou Zant. "Psychoacoustic assessment of misophonia." JASA Express Lett. 5, 094401 (2025). https://doi.org/10.1121/10.0039238.

Read more from JASA Express Letters.
Learn more about Acoustical Society of America Publications.

Music Credit: Min 2019 by minwbu from Pixabay. 

Transcript

ASA Publications (00:26)

Do you find the sound of people chewing unbearably annoying? Or perhaps you can't stand to be near folks who are typing on noisy keyboards, fidgeting with their pens, or rustling a plastic bag of chips. The term for this sort of aversion is misophonia. Even if you don't personally deal with this issue, you may know someone who does. Today I'm talking with Benjamin Kirby and Olivia Zant, whose recent JASA Express Letters article, “Psychoacoustic Assessment of Misophonia,” touches on this topic.

Thanks for taking the time to speak with me today. How are you guys doing?

Benjamin Kirby (00:55)

Really well. Thank you.

Olivia Zant (00:56)

Good, thank you.

ASA Publications (00:57)

Great! So first, just tell us a little bit about your research backgrounds.

Benjamin Kirby (01:01)

Yes. I'm an audiologist by training, and my original research focus was in the area of electrophysiology, particularly as applied to cochlear implants and hearing aids. More recently, I've been interested in developmental and cognitive contributions to listening performance on psychoacoustic tasks. So that could be for people with normal hearing or people who have hearing loss kind of across the lifespan.

Olivia Zant (01:28)

My clinical background is also in audiology, with my research background focusing on auditory neuroscience. I utilize high-density EEG in my studies to explore how the brain processes sound and why listening can be more demanding for some people compared to others. In my current research study, I study the cognitive neural factors that contribute to listening effort. More broadly though, my work is about understanding why some auditory experiences feel effortless for some and more overwhelming for others and the impact of those differences.

Much of my work is focused on adults with hearing loss, but I also work with adults with neurodevelopmental conditions, such as autism spectrum disorder. So while misophonia wasn't originally the main focus of my research, it actually does fit in fairly well with a lot of my research questions. At its core, misophonia is just another example of how differences in auditory and sensory processing can ultimately shape the way people experience sounds and interact with their environment.

ASA Publications (02:22)

Right, right, that totally makes sense. To start, what is misophonia?

Benjamin Kirby (02:26)

Misophonia is a disorder that is characterized by decreased tolerance for certain trigger sounds and related stimuli. It was first described in the early 2000s, and the term itself means “hatred of sound,” and it was coined by Pavel Yastraboff to help distinguish that condition from hyperacusis. So hyperacusis, that's a disorder where people have a decreased tolerance for sounds as a result of their intensity or the frequency content of the sound. Whereas with misophonia, the sound itself is the issue. So the identity of the sound is the thing that the person has difficulty tolerating more than its acoustic properties. Most of the trigger sounds that can elicit misophonia symptoms, they tend to be human-generated sounds that are repetitive. Most of these common triggers, they relate to eating or drinking, breathing, and interestingly, for some individuals they may also have visual triggers, so just seeing somebody, you know, eating chips be sufficient for them to experience misophonia symptoms.

ASA Publications (03:31)

That's really interesting. You know, it's funny, I don't think I realized that it was only very recently kind of recognized as a disorder.

Benjamin Kirby (03:39)

Absolutely. Yeah, there was a period of time where there was relatively little research interest in it. And I think it was only in the last 15 years or so that it has really entered the public consciousness and that more people have been interested in the disorder from a research and a clinical perspective.

ASA Publications (03:54)

So how is misophonia typically diagnosed, and what are the limitations with these diagnostic methods?

Olivia Zant (03:59)

So this is a super nuanced question and response to this. So technically in the strictest sense, misophonia doesn't yet have a formal diagnostic criteria. So it isn't currently an official diagnosis. That said, it's still recognized by audiologists, psychiatrists, and mental health professionals as a distinct and meaningful condition. So typically from like a clinical audiologist perspective, clinicians will rely on a self-reported measure and clinical case histories to diagnose, while ruling out other related conditions, such as hyperacusis, so loudness intolerance, and tinnitus, so ringing in the ears. It's also common to refer to psychology who then have their own criteria, often questionnaires and evaluations. Right now, the biggest limitation is the lack of formal diagnostic criteria. So currently, again, misophonia is not a standalone diagnosis. It is not recognized in a major diagnostic manual or international classification of disease. And so there are no true definitions or a cutoff of misophonia symptoms. I was even just reviewing a couple of my clinical audiological handbooks before this recording just to see if the term was in the glossary or if there was any chapters that touched on it, and some current clinical handbooks don't even include the term right now.

So without having a formal consensus of what misophonia is, it can be difficult to reliably distinguish it from other similar disorders, again, such as like hyperacusis, obsessive-compulsive disorder, or anxiety disorders. As I noted, audiologists in particular, primarily rely on self-reports or case history, which can lead to a lot of variability and inconsistencies in interpretation and identification. And then without further recognition in those major diagnostic manuals, like the International Classification of Disease, the legitimacy of the diagnosis can be called into question, which then can impact recognition among other healthcare professionals, insurance coverage, and inclusion in other research projects.

ASA Publications (05:56)

Okay, so it sounds like we really do need a diagnostic measure, if possible, that's, you know, formalized. So, as your article title says, you were interested in psychoacoustic assessment of misophonia symptoms. What would this type of assessment typically entail, and what kind of research has been done on this area so far?

Benjamin Kirby (06:14)

Yeah, so there has been some limited research into applications for psychoacoustic methods to the evaluation of misophonia symptoms, and that's typically involved presentation of recorded stimuli, and then the listeners would respond using a standard scale. So that might be from 1 to 10 or 1 to 100 to describe the aversiveness of each stimulus. So prior research has primarily been using large-scale online administration, so people would be taking these tasks in a variety of settings, potentially in their own homes. And there's some limitations associated with that. So those individuals might have unknown hearing status that could affect the audibility of the stimuli. They’re using unknown transducers. And potentially there are issues with background noise or other distractions interfering while they're taking the test. And also they do require the use of computers and special software. So ideally if we were to develop a psychoacoustic approach to evaluating misophonia symptoms, it could be something that would be more easily administered in a clinic even if they don't have a PC or computer or other form of software handy.

ASA Publications (07:21)

Okay, so what was the goal of your study?

Olivia Zant (07:24)

The goal of the study was really to understand how people with misophonia respond to specific trigger sounds when those sounds are carefully controlled and recorded in a lab setting. So we looked at normal hearing adults with misophonia and compared them to normal hearing listeners without any sound sensitivity concerns. Essentially, we wanted to see how intense their reactions were to common misophonia triggers and then how those reactions lined up with what they reported on standard self-report measures such as the misophonia questionnaire, or MQ. The primary hypothesis was that we expected people who showed stronger emotional or aversive reactions to the trigger sounds would also report more severe symptoms on the questionnaire. We also predicted that both the psychoacoustic task scores and the MQ scores would be higher in the misophonia group compared to the control group. 

Another important piece of the study was exploring whether the psychoacoustic testing could be a practical tool for assessing misophonia. And one of the strengths of this approach is that it lets us tightly control the trigger stimulus, so the exact sounds that are being presented are what we expect. The listening environment can also be controlled, sound levels, and even the type of headphones or speakers being used, all while accounting for a person's hearing status. Those factors aren't always well controlled in previous research or in clinical practice, so this type of design just gave us lot more control over those factors. And then in standardizing those acoustic and listening conditions, psychoacoustic measures may offer a more objective and repeatable way to assess misophonia in future.

ASA Publications (08:51)

Right, so you can actually diagnose it in the future. So what did you actually do in your study?

Benjamin Kirby (08:55)

Yes, so we recruited two groups of participants for this study. We included a group of people who reported symptoms that were consistent with misophonia. We weren't requiring them to have a diagnosis because the difficulty of diagnosis is part of the issue. We also had a group of control listeners who did not report a history of symptoms consistent with misophonia. For both groups of listeners, we screened for normal hearing, and the experiment itself we presented recordings of trigger stimuli under headphones and then the listeners would rate the aversiveness of those stimuli. The scale that we were using was a five-point scale, and it had a visual analog of, you know, smiley faces if it wasn't aversive and frowning faces if it was very aversive indeed. In addition to that, we asked them to identify each stimulus after it was presented. Finally, the participants, they completed the misophonia questionnaire, which is an established questionnaire that has been used to describe symptoms and severity of misophonia.

ASA Publications (09:58)

So for your stimuli, you actually recorded them yourselves. Can you tell us about that? Did you do anything in particular to make them extra annoying?

Benjamin Kirby (10:05)

Yes, so we did record all of the stimuli and it was a very fun process. It was like we got to be foley artists for rude sounds—which normally I try not to make, so this is kind of you know violating some taboos I think. The sounds that we selected to record, they represent some of the most commonly reported categories of misophonia triggers, so that includes breathing, drinking sounds, eating sounds, typing, plastic bags, just some of the more common triggers. I know some individuals they may have idiosyncratic triggers, where like it's a particular person producing a particular speech sound that they find very bothersome. But most people that have the condition will respond negatively to at least one of those trigger categories that we included here.

There's a lot of trial and error to get good quality recordings that gave me an appreciation for people who have to record music or record podcasts for a living. You know, just like a creaky chair or, you know, some sort of unintentional background noise could ruin a take and then we'd have to start over. And we only brought so many crackers with us, so… that could be a problem. We wanted to make sure we got representative recordings as well, so that it definitively sounded like the thing we intended it to sound like. So we found a certain brand of rice crackers gave a very good sort of crunchy sound. So we use those rather than corn chips, for instance. And there are certain things I couldn't eat at all and I was happy to have Olivia to help with that.

Olivia Zant (11:37)

Yes, I was the peanut butter sound effect artist is what we'll call that role. I honestly can't remember if I did anything in particular to make the sounds more annoying, besides maybe exaggerated mouth movements. I think the peanut butter was fully capable of making grotesque sounds on its own. What really stood out to me in this process, though, was just how silly the whole experience was. At the time I was a brand new grad student. I had a very rigid of what science was supposed to look like. And this was very different than my expectations of a research lab. And so was in this small little soundproof audiology booth, actually the same one I'm sitting in today, and making these just grotesque sounds and making these little silly crunching sounds and helping with the recording process. It was very interesting. I will say, I have yet to have such a silly recording experience, similar to the peanut butter or just any of the mouth noises that we recorded.

Benjamin Kirby (12:34)

And our participants kept us honest too. I think we had a pilot subject who caught us out on one of them because I was recording the stimulus making a smacking noise with no food in my mouth. And they pointed that one out as not sounding real or not sounding like what we were attempting to produce with that. So that's why we had to go back and do some additional peanut butter artwork.

Olivia Zant (12:58)

And yes, we were truly eating and chewing and crunching all of these. It was an involved and realistic, true process.

ASA Publications (13:07)

You brought authenticity to it, sounds like, to the research.

Olivia Zant (13:08)

yes.

Benjamin Kirby (13:10)

Yes.

ASA Publications (13:11)

So actually, you kind of made a point about identifying the trigger sounds. How well did people with misophonia identify trigger sounds? Is their ability to identify trigger sounds any different from the ability of a person without misophonia?

Olivia Zant (13:25)

So the study intentionally aimed to use trigger sound stimuli that were highly identifiable by the participants, knowing that when listeners with misophonia cannot identify a trigger sound, the subjective rating of the aversiveness of the sound do not differ significantly. So based on the responses, we succeeded. Only a small subset of our recorded stimuli were misidentified in single incidences. Specifically, listeners in the misophonia group correctly identified the 98.5 % of the time, and those misidentified stimuli were pen clicking, slurping, snuffling, and typing. 

To answer your second question, while the focus was whether the misophonia group could identify the sounds, both groups were ultimately able to identify the trigger sounds well.

ASA Publications (14:10)

So what did you find in terms of participants reactions to trigger sounds compared to the control group?

Benjamin Kirby (14:16)

Just subjectively, they would tell me in some instances that like, oh, that was a really bad one. Then they might need a moment before the next one. It was a relatively short study, but for some of these people, it was unpleasant, certainly, for those in the misophonia group. In terms of the data itself, the summed aversiveness scores were significantly higher in the misophonia group compared to the control group. So the control group would find certain of these sounds to be annoying, but overall there was a much higher level of aversiveness for the misophonia group.

ASA Publications (14:52)

Kind of what you'd expect, but good to see it proven. So how did this method for assessment of misohonia end up performing compared to previous assessment methods?

Olivia Zant (15:00)

Overall, it performed really well and lined up closely with what we're already seeing using traditional misophonia questionnaires. Listeners’ aversiveness ratings to the trigger sounds were strongly correlated with their scores in the misophonia questionnaire, which is consistent with prior research showing that stronger reactions to trigger sounds do go hand in hand with more severe misophonia symptoms. One thing that stood out in the study was that we saw strong correlations for 10 out of the 18 trigger sounds, which is a bit stronger than what's been reported in earlier work. And that may be because the trigger sounds we used, again, were intentionally easy to identify and included many common mouth-related sounds, which tend to be especially salient for individuals with misophonia, or particularly annoying, I should say, for them. Taken together, these results suggest that using standardized recorded trigger sounds paired with an aversiveness rating is a promising way to assess misophonia. It also opens the door for psychoacoustic measures to serve as a practical complementary method of diagnosing or assessing to questionnaires, adding more control and consistency to how misophonia is evaluated.

ASA Publications (16:06)

Right, right. So what are the next steps for this research?

Benjamin Kirby (16:08)

Yes, I'm currently conducting a survey of audiologists to get a better understanding of their knowledge, attitudes, and clinical practices when it comes to misophonia. So what are they actually doing in the clinic? It's kind of an open question, and some people are diagnosing the condition, some people are not. Some people are referring. Some people are working as part of a collaborative group. Just, there's a lot of variety in terms of the way that audiologists are approaching this condition and working with people that have misophonia. Another area of research I'm interested in that relates to this research directly is I'm working with a colleague who's an expert in functional imaging, and we'd like to better understand the brain regions that are associated with misophonia.

Olivia Zant (16:53)

And then I'm also continuing on with some misophonia research. I'm currently working on study up and running that will examine neural markers associated with misophonia. Because misophonia is still not really well understood, gaining insight into some underlying neural mechanisms is going to be important for informing treatment and therapy approaches. I really want to look to see if there's potentially objective biomarkers of misophonia. Sometimes biomarkers are responsive to treatment, meaning that they'll change after you've provided some type of treatment. So we're going be looking to see if there is just any objective way to track treatment effectiveness and therapeutic outcomes with intent or the hopes or goals of a future interdisciplinary collaboration with a different department.

ASA Publications (17:37)

Right, right. Yeah, it would be really cool if there were a way to help people with misophonia actually deal with the stress caused by hearing these super annoying sounds. 

Benjamin Kirby (17:47)

There's a lot of unmet need for sure in that area. And just working with people on this research study, some of the things they've reported in terms of attempted treatments of misophonia by psychiatrists or psychologists. In one case, it was just some ad hoc version of exposure therapy, where he would make this person with misophonia sit in the room with him while he ate his lunch. And supposedly that was therapeutic.

ASA Publications (18:17)

Huh, well, I mean, I guess. ⁓ Yeah, right. I can understand the idea behind it, right. Well, it like the psychoacoustic assessments like the ones you used in your study could be quite helpful in better characterizing and understanding what folks with misophonia are experiencing. you again for speaking with me today, and I wish you the best of luck in your future research.

Benjamin Kirby (18:21)

Not so much in that case.

ASA Publications (18:24)

Yeah, right. I can understand the idea behind it, right. Well, it does sound like the psychoacoustic assessments like the ones you used in your study could be quite helpful in better characterizing and understanding what folks with misophonia are experiencing. Thank you again for speaking with me today, and I wish you the best of luck in your future research.

Benjamin Kirby (18:43)

Thank you very much.

Olivia Zant (18:44)

Thank you.