Identification of a subgroup of post-9/11 veterans with unique combat experiences and worse clinical outcomes.

The concept of decreased sound tolerance is an umbrella term that includes the concepts of hyperacusis, misophonia and noise sensitivity. A complicated neurophysiological and behavioural condition with multiple underlying causes, misophonia is characterised by a heightened emotional and physiological reaction brought on by an intolerance to particular auditory stimuli. The particular sound triggers the emotional and behavioural reaction. Individuals with misophonia are generally disturbed by specific auditory stimuli, which commonly include eating-related sounds (such as chewing, smacking, slurping, or crunching), breathing, sniffing, throat sounds (e.g., throat clearing), foot tapping and machine-related noises (such as clock ticking or keyboard typing). These trigger sounds can vary widely between individuals. The condition often elicits a range of physiological responses, including increased heart rate, shortness of breath, elevated body temperature and heightened muscle tension. Emotional reactions may encompass anger, disgust, irritation, aggression, sweating and feelings of being overwhelmed. These responses are typically sound-induced and may lead individuals to develop avoidance behaviours as a coping mechanism. The reaction called is not related to the psychoacoustic properties of the sound, such as frequency and loudness, but is related to the individual’s past experiences and who or what is emitting the sound. Although the exact prevalence of misophonia is unknown, it is thought to be near 20 per cent of the population, with 6 per cent of those individuals exhibiting considerable functional impairment. Misophonia could be a more prevalent and underdiagnosed condition, likely due to its potential misidentification as other auditory disorders and its frequent comorbidity with psychiatric and auditory conditions. Although misophonia has gained increasing attention in the scientific literature in recent years, the lack of clarity regarding its pathophysiology and the absence of standardised diagnostic criteria pose significant challenges for the development of specific therapeutic interventions or treatments. In an effort to facilitate diagnosis and assess the emotional and social impact as well as the severity of misophonia, various psychometric tools have been developed. Among the most commonly used instruments in misophonia assessment are the Amsterdam Misophonia Scale, the Misophonia Questionnaire and the Misophonia Assessment Questionnaire. From an audiological perspective, there is currently no consensus on a standardised evaluation protocol for misophonia. Hearing loss may or may not be present in affected individuals. In addition to standard audiological assessments such as pure tone audiometry and acoustic immittance testing, the evaluation of loudness discomfort levels (LDLs) is recommended.