Reports of a (almost) former-Misophonic

Two photos, two moments

The first moment, on the left, was at the Christmas presentation of the Literacy class at the school where I started my studies. This day I had a fever and a sore throat. These were days that I experienced a joyful, quiet and quite noisy childhood, as it should be.

In the second moment on the right, it had been little more than four months since the first photo. It was in the outer courtyard of my house, registering in a joke, how I reacted when whistles bothered me. That picture was a record about twenty days after manifesting symptoms of auditory discomfort to specific sounds.

Two moments: Before and After Misophonia
Two moments: before and after


The beginning

In March 1977, about a month after I was seven, I underwent a surgical procedure for extraction of the tonsils. From a very early age they were frequently inflamed, and I was affected by episodes of fever of thirty-nine (39) degrees centigrade (or 102°F), insistent and occasionally causing me an unpleasant delirium, as if I felt the friction caused by the texture of some objects passing through my head.

The surgery was prescribed by the pediatrician who attended me and  was performed at the Beneficencia Portuguesa Hospital. Before the surgery, in the ward, I was able to talk to another child who was also going through the same surgery and other children and there were others who were hospitalized for various reasons. All the parents and nurses repeated that the next day I would be fine and could have ice cream. So, I went into the surgery room and 3 seconds after the general anesthesia, I turned it off.

I woke up at the surgery room with blood in my mouth and nose and spent the night in the nursery. The next day I went home, could not eat anything and all the sounds were hurting in the ears ... I stayed a month like this, until the sounds stopped hurting and the inflammation gave in. However, I began to realize that in two situations I felt a nuisance: my brother's whistle and a sound that I had never noticed before, that of cleaning the teeth by suction or simply - sucking the teeth.

Other people I met who also went through this surgery did not report a time of recovery so complicated. At that time, they stayed home for a short and brief period. However, I did not meet anyone who took ice cream the day after extracting the tonsils.


Here is a brief analysis of how I have dealt with Misophonia - trigger by trigger, considering the hypotheses I have been studying and are cited in the most diverse academic studies about Misophonia and of course, my perception of each trigger considering its evolution in me from the beginning.

For those who are now familiar with Misophonia, trigger is a specific sound that starts exaggeratedly the aversive responses like anguish, anger, hate and other negative emotions. I never mention that it is a "noise", because in my perception this confuses with Hyperacusis, which depends more on the intensity or the tone of the sound.




Some people report that by reading about a particular trigger, they begin to feel uncomfortable with it. So, if you do not like reading about triggers skip this text until the topic: My considerations.


The triggers




It was the first trigger I could tell. It causes in me the aversion described in the accounts of misophonia, but also a physical nuisance in the right ear. I suspect of dehiscence in the right upper canal, like the upper channel of the cochlea entered the skull bone. As the skull bones also pick up sound waves, the whistle can transmit vibrations to this channel. Other than that, when I started to feel aversion to whistling, I still had my older brother whistling, which traumatized me even more, accentuating the suffering and conditioning me negatively for it emitted a sharp and intense whistle that he did, thinking that I was only taking advantage to have more "pampering" of the people close. He tortured me a lot, but he was not aware of what was going on inside me.

This negative experience with my brother is consistent with a hypothesis that I have found in research as one of the causes of misophonia: a conditioning process or reflex conditioned to a traumatic situation.

It could be explained in many reports where eating discomfort is mentioned, with the family at the table, especially in childhood. In my case, it was very traumatic, because the inflammation that followed after the surgery caused sore throats and ears and made me spend days in bed, because any sound at any intensity bothered me. After a month what bothered were specific sounds that were potentiated by my brother. There we also could suspect of Post-Traumatic Stress. But I was in the world of 1977 ... who could diagnose this?

Today, Post Traumatic Stress Disorder (PTSD) has treatment.

The suspicion that has arisen with the otorhinolaryngologist since 2017 is that postoperative inflammation has functionally altered some structures of the middle and inner ear and, therefore, protection against loud noises. It may explain the Hyperacusis that affected me about a month until the inflammation subsides. It may also have started a compromised upper ear canal.


Chewing and sucking teeth


The hypothesis is, with me, related to OCD - Obsessive Compulsive Disorder. The treatment of OCD with Cognitive Behavioral Therapy (CBT) is decreasing the perception and reaction to this trigger. Looking at my background, when I was seven, I began to notice that the sounds of sucking teeth affected me, I searched for a book and began to tear it to the top of each sheet. The tear was proportional to the nuisance, like: quick sucking I would tear less than a centimeter; the "deeper rips" were proportional to the longer sound. Interestingly, due to the numbering of the pages of the book and the rhythm that the people around me produced this trigger, I began to count how many times I perceived the trigger sound.

It was the beginning of counting "things" in other situations, like the posts I saw on the road during a trip or the steps I made to a destination. And when I started, I could not stop, I was in an anxiety and I had to keep counting. So, every time someone "sucked their teeth," I was already counting and waiting for the next one. Then I started bothering to suck up almost everything from bones, soup to fish bones, and finally the open-mouthed chewing.

It is worth mentioning here that before that I did not even realize that people sucked teeth. It's like it's a new sound in the world for me. The worst is that people do it without realizing it, because, most of the time, it is automatic.

So, in my case, for these triggers, the strategies of dealing with OCD has diminished the nuisance. At present I almost do not notice symptoms similar to OCD.


Sanding surfaces


These sounds do not cause aversion like others, but a feeling that sandpaper is acting on my spongy brain tissue. It's the only way I can illustrate it (lol). Of course, it's disrupting my attention. It is interesting that this sensation was similar to the feeling during the episodes of delirious fever. Before the surgery and Misophonia treatment. Suddenly it's an ultra-exaggerated ASMR effect. ASMR is the autonomous sensory meridian response, because, unlike those who suffer from Misophonia, some feel a “chilling” pleasure when they hear some sounds, such as people whispering.


Percussed sounds or beaten in general


I managed to overcome this trigger with emotional control of anxiety and habituation and CBT. I had already explained in another publication in the support group [Misophonia - Syndrome]. The most percussive sounds I hear most are people drumming on the tables while they work, sounds of steps on the ceiling, pens with retractable tip being driven, keyboards, etc ... None of them affect me anymore. So, for this trigger I think there was a total "cure."


Noises in general


I only call noise a sound or a loud noise. Since they are not any of the above triggers, they do not bother me within the limits that my sense of hearing can support or depending on the activity they are performing. That is, I do not currently suffer from HYPERACUSIA. Either way, I avoid very noisy environments for a long time, so as not to worsen hearing problems and be another stress point when it comes to reacting to a trigger. So, I will not be found, spontaneously, on show with speakers pouring out all the power.




I notice 4 types of tinnitus. Two are constants. In one of them it sounds like a cricket sound all the time, but it becomes more apparent the quieter the environment is and the other is almost a squeak, resembling White Noise. I'm so used to them that I hardly notice them anymore. I believe that the therapy for the percussive sounds has immunized me to the buzzing present "inside my head". There are still 2 more buzzing sounds that are sporadic and I notice them more in the left ear. They sound more like a pure tone and one of them could compare with an application that generates tones with the triangular waveform and range from 4,000 Hz to 6,000Hz. I have Sensorineural Hearing Loss (SNHL)  at 4,000 Hz, according to the last audiometry I performed.


I only mentioned these five: Whistle, sanding, chewing, sucking teeth and beats, because they are the ones that stood out the most in 42 years living with the problem. After a long suffering and with no prospect of improvement, I became irritable to other stimuli. Specific sounds, people with linguistic markers (ok, okay, no, no, understood, understood), Wheezing (very strong "S" phrase endings) and even various annoying situations involving dealing with people. All of these, in my view, are triggers of 'behavioral background' provoked by the distortion that suffering from Misophonia causes, in those who experience the problem. That`s why in support groups there are so much irritation reported against people, animals or objects that produce triggers. In my case, attitude changes and psychotherapies, independent of the therapist's knowledge about misophonia, may help and even resolve, but will depend on the therapist's abilities to use various approaches and discard the presence of other medical or psychiatric problems. I have quite used the CBT assumptions together with a behavioral therapist and this has helped me to reduce those episodes of disgust. For these "behavioral" triggers I consider that I am almost healed. And healed does not mean that I tolerate it when I hear them, but that I barely even notice them.


My considerations

It is possible to notice in the above paragraphs that for each trigger there is a different approach and therapeutic conduct, since the Anamnesis - which consists in the history of all the symptoms narrated by the patient, is distinct for each of us and for each trigger. I recommend performing this Anamnesis with a well-qualified Psychologist because they have the most effective tools to help you determine what differs for each trigger at the level of feeling / emotion and considering trauma to situations that we sometimes do not even remember. I have been conducting this anamnesis in parallel with an Otorhinolaryngologist, because tests to check Loudness Discomfort Level (LDL), Central Auditory Processing Disorder (CAPD) complement and other possible hearing problems. With a Psychiatrist we will be approaches to evaluate other aspects of our mental health, such as levels of depression, anxiety, dissociative disorders etc. With Neurologist we can verify some chemical imbalance of our brain and presence of tumors. This is a multidisciplinary approach. I have read many reports of misophonics in support groups, where they complain of failure when the consultation is directed only to a specialty and especially when these professionals do not know or have never heard about Misophonia.


I insist that an approach with just one professional may not be successful because it does not help to address, for example, emotional and / or behavioral aspects with Cognitive Behavioral Therapy, Hypnosis, Brainspotting, EMDR, Neurofeedback, Acupuncture and other valid treatments , whether there is the possibility of some kind of chemical imbalance in the brain, or other medical, speech-language or psychiatric disorders, acting together. Recalling that the relationship between Misophonia and these situations is still unknown.


Having said that, I will add that I have had extreme situations of being bothered, having hate, wanting the evil of those who produced sounds, especially in my 20 and 30 years, but I understood later that - reverberate hatred and intolerance, regardless of being because of Misophonia or the world, does not help, only worsens the symptoms with time. I am grateful to mature with this understanding.


I'm not a special being, I just fought and fought against Misophonia and not against sounds. However, there is nothing to stop us from taking protective / preventive measures if others abuse the quiet of others. The problem is when these measures are the main strategy because - the world will not be quieter, on the opposite.

So, beyond the protective measures, measures to treat the root of everything - MISOPHONIA - need to be taken seriously.


I hope this text will bring you new insights on how to tackle Misophonia trigger by trigger. I pray that everyone can deal with problems with life and Misophonia.


And now the final moment

After the text is published in the support group and just before doing it here, I've started a treatment that uses a protocol for Misophonia. In the first session, the sound of a whistle did not affect me. In the second session the therapist chewed, without realizing it, a candy and I did not even got bothered. In the third section I let, for a few minutes, notice the buzzing (wheezing and crickets). I'm just at the beginning of this new treatment. Let us say that it is an experimental protocol to treat Misophonia, but I hope that in a future publication about my advances, it will be a case record - of success - to be replicated in a scientific journal, thus allowing other professionals and researchers to establish a treatment for all.

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Alexandre Mota
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