Hyperacusis, Misophonia, & Phonophobia Hyperacusis is abnormal sensitivity to everyday sound levels or noises. Often sensitivity is more pronounced at higher pitched sounds. Many of these patients have essentially normal hearing. Currently, hyperacusis has been associated with certain types of head injuries, i.e., closed head injury (even mild in nature). Noise induced trauma, ingestion of therapeutic drugs, toxic reaction to poison/venom, post-traumatic stress disorder, auto accidents with whiplash or neck injury, sudden onset of tinnitus, extended use of earplugs, meningitis, Lyme Disease, vestibular disorders and Menier's disease are all strong factors for creating hyperacusis. Misophonia is a general dislike for sounds and is developed due to abnormally strong connections between the autonomic and limbic systems in the brain, Phonophobia is fear of loud sounds due to its potential damaging effects. It is generally associated with migraine, but many tinnitus patients, without migraine do have phonophobia. Most patients with hyperacusis have certain degrees of phonophobia or misophonia or both. Tinnitus Retraining Therapy (TRT) is an effective treatment approach for many individuals with hyperacusis, even in some of the most severe cases. TRT is a treatment initially designed for tinnitus, but subsequently was found to be successful for hyperacusis treatment as well. Many patients with hyperacusis strongly believe that their condition results directly from damage to the inner ear. However, crucial in this review is acceptance of the concept that hyperacusis is primarily a disorder of central auditory processing. Dr. Marghzar's doctoral dissertation focused on hyperacusis and its possible physiologic reason. His findings strongly suggested that a pathway from brain to the ear has something to do with hyperacusis (please email us for an abstract). Directive counseling for people affected by hyperacusis is typically very intense. The counseling involves a detailed individualized explanation of the mechanisms involved with hyperacusis and the role these mechanisms play in the auditory pathway. This detailed explanation often must be re-iterated and paraphrased at intervals. Counseling must come from a knowledgeable yet compassionate source. It must be conducted according to the guidelines of TRT as described by Dr. Jastreboff and Dr. Hazell, and the counselor must be thoroughly versed in the principles of TRT. The counselor must also be willing to be reasonably accessible to the patient and the patient must be willing to follow through on the counselor's recommendations, and not discontinue the program prematurely. Most patients see some levels of improvement in 8 weeks.