Hyperacusis and misophonia are often confused. They both fall under the umbrella of ‘decreased sound tolerance’. Even for doctors, it can be hard to tell them apart. But it’s essential to know the difference between hyperacusis and misophonia to find way the best way to cope.

Rage vs. Pain

Do you hate the sound of people chewing, pens clicking, plates clattering and paper crinkling? All of them? Diagnosis: hyperacusis. Yep, really. 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.

Misophonia triggers a noise-induced rage, an instant reaction that’s hard-wired and probably inherited. It doesn’t have anything to do with the loudness or frequency of a sound. It’s more context-related. Even soft sounds, or sometimes especially soft sounds, cause anger, rage or panic. 

Hyperacusis, on the other hand, is a noise-induced pain. It usually develops 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.

difference between hyperacusis and misophonia

Sirens, horns & trombones

Hyperacusis has often to do with a physical injury or illness. A blow to the head, Lyme disease, floxie poisoning and ME/chronic fatigue can all cause these symptoms whereas misophonia is more hard-wired. Someone with hyperacusis literally feels pain in the ear canal while misophonia expresses itself in anger or panic. 

When you deal with hyperacusis there might be a late reaction that lingers on for days, weeks or even months. Misophonia ‘causes symptoms you feel in your whole body: sweaty palms, a racing heartbeat, and a tight chest. Often it dissipates as fast as it came. 

When a parade passes by – sirens, horns and 76 trombones – it might mean months of fullness, ringing, sensitivity, and pain to someone with hyperacusis. To someone with misophonia, it all depends on the faster whether that noise is a trigger or not. Louder can even be better for someone with misophonia because there’s more ability to drown out triggers.