Estimation of Prevalence of Misophonia Among High School Students in India.

Objective: Misophonia, an intriguing psychological disorder is characterized by intense emotional responses to specific sounds produced by others, has gained prominence for its distinct attributes and profound impact on individuals' emotional and psychological well-being. This study addresses the scarcity of research on misophonia's prevalence and severity among high school students, aiming to shed light on the unique challenges faced by this demographic in India. Methods: The study enrolled 597 high school students, including 269 females and 328 males, aged 14 to 16, with no history of psychological or otological problems or medication use. The Misophonia Assessment Questionnaire questionnaire, consisting of 21 questions with a 4-point Likert scale response, assessed emotional and behavioral reactions to sensitive sounds. Participants' scores categorized them as Sub-clinical, Mild, Moderate, or Severe misophonia. Results: The prevalence of misophonia was 34.67% among high school students, with 52.65% categorized as Mild, 45.41% as Moderate, and 1.93% as severe misophonia. A comparison with a similar study on college students in India revealed a higher prevalence of misophonia among high school students. This discrepancy may relate to adolescents' vulnerable psychological states, marked by limited emotional regulation and significant life transitions. Conclusions: This study significantly contributes to the evolving understanding of misophonia by spotlighting its prevalence and severity among high school students in India. The findings underscore the necessity of recognizing and addressing misophonia's impact during adolescence, a crucial developmental phase.

Impact of Otitis Media With Effusion in Early Age on Auditory Processing Abilities in Children: A Systematic Review and Meta-Analysis.

Objective: Early-onset otitis media with effusion (OME) can affect the development of the auditory nervous system and thus lead to auditory processing abnormalities. This study aims to review the effect of childhood OME on auditory processing abilities in children. Methods: A systematic review of the literature, restricted to the English language from 1990 to 2022 was conducted using search engines like PubMed, Embase, and Google Scholar. After selecting the articles following predefined inclusion and exclusion criteria, the data were extracted and meta-analysis was performed. Results: A total of 10 articles met the inclusion criteria. Children with a history of OME had poorer performance in most behavioral and electrophysiological tests. Pooled analysis of various tests such as the gap in noise test, frequency pattern test (verbal and nonverbal), and latencies of auditory brainstem response-I, V, I to III, and I to V showed a difference between the 2 groups. Conclusion: Childhood OME can significantly affect auditory processing abilities in children.

Auditory cortical functioning in individuals with misophonia: an electrophysiological investigation.

PURPOSE: Misophonia is characterized by a reduced tolerance for specific sound triggers. This aspect has been relatively underexplored in audiology, with limited research from the audiological angle. Our primary objective is to compare the auditory late latency response (ALLR) findings between individuals with misophonia and those without it. METHODS: A study compared individuals with significant misophonia to a healthy control group. Thirty misophonia participants were categorized into mild and moderate-to-severe groups based on their Amsterdam Misophonia Scale scores. The latency and amplitude of auditory response peaks were analyzed across the groups using the ALLR. Statistical tests included Shapiro-Wilk for data normality, one-way ANOVA for group differences, and Bonferroni post hoc analysis for detailed variation sources. RESULTS: The result showed a significant difference in latency of P1 and N1 peaks (p < 0.05) of ALLR between the groups in both ears. This suggests a deficit in auditory processing at the cortical level in individuals with misophonia. CONCLUSION: Our study substantiates the potential utility of the ALLR as a valuable instrument for evaluating misophonia, particularly from the audiological standpoint.

Differential advantages of musical backgrounds on binaural integration and interaction skills in instrumentalists, vocalists, and non-musicians.

Background: Musical perception requires a host of skills. Instrumental musicians place greater emphasis on motor coordination, whereas vocal musicians rehearse vocal sounds. The study explored the differential advantages of musical background on binaural integration and interaction in musicians (instrumentalists, vocalists) and compared them with age-matched non-musicians. Methods: Eight six participants aged 20-40 y with normal hearing sensitivity were subjected to binaural tests using a standard group comparison research design. The participants were segregated into three groups - Group 1 included instrumentalists (n = 26, mean age: 17.73 ± 2.83 y), while Group 2 and Group 3 consisted of vocalists (n = 30, mean age: 19.30 ± 2.47 y) and non-musicians (n = 30, mean age: 18.20 ± 3.02 y) respectively. The binaural processes namely integration (Dichotic syllable test, DST; and virtual acoustic space identification - VASI) and interaction (Interaural difference thresholds for time and level: ITD & ILD), were administered on all the participants. Results: Statistical analyses showed the main effect of musicianship. Bonferroni pair-wise test revealed that the musicians (instrumentalists and vocalists) outperformed (p < 0.05) non-musicians in all the tests. The differential advantage of the musical background was seen on the binaural integration test with instrumentalists performing better in the VASI test compared to vocalists, and vice-versa for DST. No difference was observed in interaction tasks (ITD & ILD) between vocalists and instrumentalists (p > 0.05). Conclusion: Musical background-induced differential advantages can be reasonably noted in the binaural skills of instrumentalists and vocalists (compared to non-musicians).

Normal linear and non-linear cochlear mechanisms and efferent system functioning in individuals with misophonia.

BACKGROUND: Misophonia, a condition characterized by heightened sensitivity and strong emotional reactions to specific sounds, has sparked considerable interest and debate regarding its underlying auditory mechanisms. The study aimed to understand the auditory underpinnings of two such potential inner ear systems, non-linear and linear outer hair cell functioning along with auditory efferent functioning in individuals with misophonia. METHODS: 40 ears with misophonia (20 participants) and 37 ears without misophonia (20 participants), both having normal hearing sensitivity were included in this study. Transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) were obtained in two conditions (with and without contralateral noise). RESULTS: Results of independent-samples t-test showed no statistically significant difference (p > 0.05) in the absolute amplitudes of both TEOAEs and DPOAEs between the individuals with and without misophonia. There was no statistically significant difference (p > 0.05) observed in the magnitude of suppression amplitude between the two groups for in both TEOAEs and DPOAEs between individuals with and without misophonia. CONCLUSION: These results suggest that the cochlear and efferent auditory underpinnings examined in this study may not be major contributors to the development or manifestation of misophonia.

Indicators for cochlear implantation in children with auditory neuropathy spectrum disorder: A systematic review.

PURPOSE: ANSD refers to a group of auditory diseases demonstrating intact outer hair cells and desynchronized neural firings of the auditory nerve. A cochlear implant is a promising intervention strategy for severe to profound sensorineural hearing loss (SNHL). However, due to its variable outcomes in children with ANSD, a consensus has yet to be reached on its performance. This study aimed to review the literature to determine the efficacy of cochlear implants in children with ANSD and to determine prognostic indicators. The study identifies the pre-operative and post-operative predictors of success for CI in children with ANSD. METHOD: The review was carried out using PRISMA guidelines. This resulted in 9630 topic-related articles. Among these, 17 articles met the inclusion and exclusion criteria that were included for the study. The quality and potential risks associated with each article were evaluated using the quality impact assessment protocol (QUIPS) tool. RESULTS: A review of 17 articles was conducted to highlight these predictors. Most selected studies included case reports, case series, cohorts, and comparisons between children with ANSD and SNHL. Assessment of study quality reported an overall low risk of bias. The overall result showed cochlear implant would be an effective option for children with ANSD. However, there are specific prognostic indicators about which clinician needs to be aware before recommending CI for children with ANSD. Our review study identified a set of pre-operative and post-operative indicators that predicted speech and auditory performance and gave some insight into the lesion site in ANSD individuals. CONCLUSION: This review concludes CI is an effective option for children with ANSD. However, before recommending CI, a detailed assessment is required from different perspectives, which could serve as predictors of postoperative outcomes. This review highlights the need to include more precise tools, such as genetic testing to describe the lesion site to choose the most appropriate management strategy for children with ANSD. Knowledge about the prognostic indicators and the effective assessment protocols would help clinicians for the better candidacy selection.

Auditory brainstem functioning in individuals with misophonia.

Purpose: Misophonia is not investigated much from an audiological perspective. Our study aims to examine the processing of the auditory retro-cochlear pathways in individuals with misophonia. Methods: A cross-sectional study was conducted among university students who had misophonia. The revised Amsterdam Misophonia Scale was used to determine the severity of misophonia. Participants were divided into mild and moderate-severe misophonia and compared with the healthy control group. Auditory Brainstem Response testing was recorded from all the individuals with misophonia. The absolute latency, amplitude, inter-peak latency difference, and inter-rate latency difference were compared between the groups. Results: One-way ANOVA result showed no significant difference in all the parameters of auditory brainstem response between the groups. These results are suggestive of normal brainstem processing in individuals with misophonia. Conclusions: The study concludes that the auditory pathway up to brainstem areas is intact in individuals with misophonia. Further studies are essential on a larger population for generalizing the results.

Binaural Processing and Auditory Working Memory in Individuals with Tinnitus Having Normal Hearing Sensitivity.

BACKGROUND: Tinnitus is a sound perceived in the ears or head without any external or internal sound source. It can be hypothesized that the auditory processing at the different levels of the auditory pathway and working memory may get affected due to the additional sound contributed by tinnitus. The objective of our study is to evaluate binaural processes and working memory capacity in individual with tinnitus having normal hearing sensitivity. METHODS: The binaural interaction process was evaluated using the interaural time difference and interaural level difference. Similarly, the binaural integration process was assessed using the dichotic consonant-vowel test, and the working memory was assessed using the audio descending span test and Audio 2N-Back span test. Mann-Whitney U test was done to see the significant difference between the groups. RESULTS: The Mann-Whitney U test showed significantly poorer interaural level difference scores in the tinnitus group. Also, dichotic consonantvowel test scores and auditory working memory test scores were found to be significantly lower in individuals with tinnitus. CONCLUSION: The binaural processes, along with the working memory capacity, are found to be affected in an individual with tinnitus, which in turn may affect the speech perception ability of the individual.

Effect of Contralateral Acoustic Stimulation on Temporal Processing Abilities in Individuals with Normal Hearing.

The aim of the article was to compare the conditions of silent and contralateral noise on the temporal processing parameters. A total of 40 participants (20 males and 20 females) were enrolled in the study with a mean age of 21.7 years, participants with normal hearing thresholds and no history of middle ear pathology were enrolled for the study. The temporal processing tests such as duration discrimination test, gap detection test, and temporal modulation transfer function tests were carried out in these 40 individuals in the two conditions of silent and contralateral noise using MATLAB. Statistical analysis was carried out using the SPSS version 25.0 were descriptive and inferential statistics were carried out. Data was normally distributed on the Shapiro-Wilk's test of normality due to which a paired t test was carried out to establish the nature of significance between the silent and contralateral noise condition. Results reveal the presence of significant difference (p < 0.01) between the groups for all the parameters of temporal resolution with contralateral noise condition performing better than silent condition for the parameters. There is a positive effect of the efferent auditory pathway on the temporal resolution parameters thus implying that speech perception in noise is improved in the presence of background noise for normal hearing individuals due to this effect.

Prevalence of Misophonia in College Going Students of India: A Preliminary Survey.

Misophonia, meaning "hatred of sound", is a proposed neurological condition in which certain sounds trigger emotional or physiological responses others may deem unreasonable. The studies on prevalence of misophonia show that almost 20% of college going students exhibit experience misophonia like symptoms worldwide. These studies help us understand that decreased tolerance towards certain sounds has a high prevalence rate. In a country like India, the diversity in terms of exposure to various levels of noise and traditional habits spans across different age groups, locations, socio-economic statuses, and communities. This study aims to establish the prevalence rate and severity of misophonia in college going-students of India and also an attempt to determine gender dominance. The total participants were 328 undergraduate students all over India, with diverse cultural, linguistic, and economic backgrounds. An online survey was conducted through Google forms, wherein the participants filled the self-rating Amsterdam Misophonia Scale and Misophonia Questionnaire. The results of the study showed that the prevalence of misophonia was approximately 15.85%, with a moderate to severe degree of misophonia. The results indicate that misophonia is highly prevalent in India and there is no gender dominance in experiencing misophonia.

Delta Variant of Covid-19 and Hearing Loss.

The Coronavirus Disease of 2019 has now become one of the biggest pandemics of all time. Under the influence of ongoing mutations and widespread geographical expansions, several variants have been reported. Among those, the B.1.617.2 variant, most commonly known as the 'Delta variant' of the coronavirus disease - 19, was first reported in the state of Maharashtra of India in December 2020 and have currently been detected in over 43 countries across six continents around the globe. The B.1.617.2 variant of COVID 19 is a more treacherous variant than the alpha variant due to the increased replication leading to higher viral loads and increased transmission with minimal literature reporting about vaccines' efficacy. In patients with the Alpha variant of COVID-19, hearing loss was an infrequent symptom seen, but on the other hand, the Delta variant happens to have a more frequent hearing loss as a symptom. The increased severity could be one of the reasons why hearing loss could be a typically seen symptom with high chances of occurrence of either a thrombosis, cross-reaction, labyrinthitis/neuritis, etc. and thus audiologists and otolaryngologists must be prepared for the post effect of the delta variant to evaluate and rehabilitate the individuals affected with hearing loss. The following article discusses the presence of hearing loss in individuals with delta variant of COVID 19 and the role of audiologists and otolaryngologists in hearing care.

Awareness and perspectives of audiologists on assessment and management of misophonia in India.

Background: The assessment and management of misophonia need a team approach, and audiologists are essential team members. However, the role of an audiologist in this condition is not well understood, and there is a lack of awareness even among professionals about their role in the assessment and management of misophonia. Purpose: The main aim of our study is to document the present level of awareness and knowledge about misophonia assessment and management among audiologists in India. Methods: A descriptive cross-sectional study was carried out among audiologists from all over India. Descriptive statistical procedures were measured based on the type of questions being addressed, and a non-parametric chi-square test was done to see the association among variables. Results: The results show a lack of knowledge about misophonia even among audiologists, as only 15.3% of the audiologist reported being confident in handling cases with misophonia. Conclusion: Although the exact assessment and management of misophonia is still the topic of debate, it is clear that audiologists are the team's key members. However, the results clearly show a lack of confidence in handling cases of misophonia among audiologists in India. This result shows the future need for Research in misophonia from an audiological perspective.

Auditory Electrophysiological and Perceptual Measures in Student Musicians with High Sound Exposure.

This study aimed to determine (a) the influence of noise exposure background (NEB) on the peripheral and central auditory system functioning and (b) the influence of NEB on speech recognition in noise abilities in student musicians. Twenty non-musician students with self-reported low NEB and 18 student musicians with self-reported high NEB completed a battery of tests that consisted of physiological measures, including auditory brainstem responses (ABRs) at three different stimulus rates (11.3 Hz, 51.3 Hz, and 81.3 Hz), and P300, and behavioral measures including conventional and extended high-frequency audiometry, consonant-vowel nucleus-consonant (CNC) word test and AzBio sentence test for assessing speech perception in noise abilities at -9, -6, -3, 0, and +3 dB signal to noise ratios (SNRs). The NEB was negatively associated with performance on the CNC test at all five SNRs. A negative association was found between NEB and performance on the AzBio test at 0 dB SNR. No effect of NEB was found on the amplitude and latency of P300 and the ABR wave I amplitude. More investigations of larger datasets with different NEB and longitudinal measurements are needed to investigate the influence of NEB on word recognition in noise and to understand the specific cognitive processes contributing to the impact of NEB on word recognition in noise.

Test re-test reliability of virtual acoustic space identification (VASI) test in young adults with normal hearing.

Background: Recent developments in virtual acoustic technology has levered promising applications in the field of auditory sciences, especially in spatial perception. While conventional auditory spatial assessment using loudspeakers, interaural differences and/or questionnaires are limited by the availability and cost of instruments, the use of virtual acoustic space identification (VASI) test has widespread applications in spatial test battery as it overcomes these constraints. Purpose: The lack of test-retest reliability data of VASI test narrows its direct application in auditory spatial assessment, which is explored in the present study. Methods: Data from 75 normal-hearing young adults (mean age: 25.11 y ± 4.65 SD) was collected in three sessions: baseline, within 15 min of baseline (intra-session), and one week after baseline session (inter-session). Test-retest reliability was assessed using the intra-class correlation coefficient (ICC), coefficient of variation (CV), and cluster plots. Results: The results showed excellent reliability for both accuracy and reaction time measures of VASI, with ICC values of 0.93 and 0.87, respectively. The CV values for overall VASI accuracy and reaction time 9.66% and 11.88%, respectively. This was also complemented by the cluster plot analyses, which showed 93.33% and 96.00% of temporal stability in the accuracy and reaction time measures, indicative of high test-retest reliability of VASI test in auditory spatial assessment. Conclusions: The high temporal stability (test-retest reliability) of VASI test validates its application in spatial hearing test battery.

Understanding misophonia from an audiological perspective: a systematic review.

PURPOSE: Misophonia is a neurophysiological disorder in which certain sounds trigger an intensely emotional or physiological response caused by an increased autonomic nervous system reaction to the triggers. Misophonia is a relatively new condition, and the neurophysiological mechanism behind this condition is not known yet. The assessment and management of misophonia need a team approach. Audiologists are vital members of the team. However, their roles in this condition are not well-understood. The study aims to review the neurophysiological mechanism of misophonia, highlighting the mechanism involved in the audiological pathway and directing the discussion toward applications of findings in the assessment and management of misophonia from the audiological perspective. METHODS: We reviewed 12 articles from different databases to understand the neurophysiological mechanisms of misophonia. Most of the studies selected were experimental designs involving individuals with misophonia. RESULTS: The result of the review revealed abnormal activation and connection among the different higher cortical structures in participants with misophonia. By signifying various neurophysiological and neuroradiological findings, the review confirms that misophonia is a neurophysiological disorder that may border between audiology, neurology, and psychiatry. Assessment of study quality reported an overall low risk of bias. CONCLUSIONS: This review highlights the need to include an audiologist as a team member in the evaluation and management of misophonia.

Gender differences in contralateral suppression of spontaneous otoacoustic emissions in individuals with auditory neuropathy spectrum disorders.

PURPOSE: The current study aims to evaluate gender variations in the efferent auditory system functioning in the ANSD population and compare them to normal hearing persons using contralateral suppression of spontaneous OAE (SOAEs). METHODS: For the current study, a total of 54 ears were considered prospectively. 27 ears with normal hearing (NH) sensitivity were in group I, while 27 ears with ANSD were in group II. All of the subjects had a regular audiological examination followed by synchronised SOAE recordings with and without broadband noise (in the contralateral ear) at 50 dB SPL and statistical analysis was carried out. RESULTS: Wilcoxon signed rank test revealed a significant decrease in SOAE amplitude with contralateral noise stimulation in NH, while no such trend was observed in ANSD. However, contralateral SOAE stimulation resulted in significant high-frequency shifts for both the ANSD and NH groups in the noise condition. In the comparison of gender effects on SOAE amplitude and frequency shifts using Mann-Whitney, no significant gender differences were seen. The lack of gender differences in SOAE suppression is explained based on global standing wave theory and local oscillator theory. CONCLUSIONS: Contralateral effect of noise on SOAE shows frequency shifts, but not amplitude shifts both of which are not affected by gender effects.

Profiles and predictors of onset based differences in vocal characteristics of adults with auditory neuropathy spectrum disorder (ANSD).

Purpose: Onset-based differences are understudied in Auditory Neuropathy Spectrum Disorder (ANSD) in dimensions such as voice, which is addressed in the study. The study aimed to profile and predict the best metrics of onset-related differences in acoustic vocal characteristics of early and late-onset ANSD patients. Methods: 31 participants (15 early and 16 late-onset) aged 15-30 years diagnosed with ANSD were included in the study. The sustained phonation of vowel /i/ recorded by the participants using android based smartphones of selected configuration was sent over email to the experimenter. Acoustic parameters (fundamental frequency, harmonic frequencies, jitter, shimmer, harmonic-to-noise ratio, cepstral peak prominence -CPP, and pitch sigma) were analysed using Praat software. Results: Results revealed significantly increased (p < 0.05) fundamental frequency along with decreased F2 and F3 of /i/ in the early-onset ANSD compared to the late-onset group, which can be explained based on differences in the pathophysiology of the disorder. Although not statistically significant, mean perturbations (jitter and shimmer), harmonic-to-noise ratio, cepstral peak prominence, and pitch sigma were more affected in the early-onset group, reflective of lowered auditory feedback and periodicity in their voice samples. Results of discriminant analysis marked the emergence of F2, F3, and CPP as the most sensitive metrics for onset-based group differences in voice characteristics. Conclusions: The findings from the study highlight the role of acoustical voice evaluation (especially CPP, F2 & F3) in verifying the onset of ANSD disorder. The insights from the onset-based differences seen in vocal characteristics can indirectly help audiologists in deciding the management options for ANSD.

A comparison of the quality of life of parents of children using hearing aids and those using cochlear implants.

Objective: The goal of this study was to evaluate the quality of life of parents of children who use hearing aids (HA) with those who use cochlear implants (CI) in the Indian context and document any differences found. Methods: The Kannada version of the AQoL-4D was administered in a modified fashion to 131 parents (87 HA and 44 CI). Sociodemographic details were collected for supplemental information on the intervention strategy used. Results: A total of 49 parents (29 HA and 20 CI) responded to the questionnaire sent. The mean total scores for both the groups were similar (HA group = 17.9 (SD = 5.5), CI group = 17.2 (SD = 3.4)), as was the score for the first subscale (HA group = 8.6 (SD = 2.9); CI group = 8.5 (SD = 2.6)) of the AQoL-4D. No significant differences were found between the two groups on either scores [Total Score: U (NHA = 29, NCI = 20) = 280.5, z = -0.194, p > 0.05; Subscale 1 Score: U (NHA = 29, NCI = 20) = 281.5, z = -0.176, p > 0.05]. The degree of hearing loss in the hearing aid group was equivalent to that of the cochlear implant group but this did not appear to influence parental quality of life. Conclusion: Parents of children with hearing aids and cochlear implants appear to be similar on several psychosocial factors in the realms of functional, social, and psychological well-being. In terms of parental quality of life, hearing aids and cochlear implants appear to be equally effective intervention techniques.

Effect of diurnal changes on dichotic listening in younger adults with normal hearing.

Background: Diurnal changes can be defined as the time of the day over an individual's performance level for different activities that involve physical and mental tasks. Objective: The current study aimed to evaluate the effect of diurnal changes in scores obtained for the Dichotic Consonant-Vowel paradigm by young adults with normal hearing sensitivity. Method: Based on the 'Morningness-Eveningness questionnaire' given by Horne & Ostberg, the subjects were divided into moderately-morning, intermediate and moderately-evening categories. The Dichotic Consonant-Vowel tests were performed during morning and evening, and the right ear, left ear and double correct scores were compared between morning and evening for each category. Results: There was significant diurnal changes noted for moderately morning and evening categories, where morning-type individuals performed better during morning and evening-type individuals performed better during the evening. The scores of intermediate individuals remained unchanged between morning and evening test results. Conclusion: Diurnal change is a phenomenon associated with an individual's biological clock mechanism. Hence, attention and inhibitory controls aid them in carrying out tasks that require sufficient physical and mental efforts. The current study suggests that clinicians and researchers consider diurnal changes as an extraneous variable that could affect the reliability of the Dichotic Consonant-Vowel test results.

Evaluation of auditory working memory in Bharatanatyam dancers.

Background: Neuroplasticity is a phenomenon exhibited by our nervous system as an indicator of overall development and in response to training, injury/loss of particular function, treatment/drugs and as a result of stimulation from the surrounding environment. Objective: The aim of the current study was to assess the auditory working memory capacities in Bharatanatyam dancers. Method: The participants comprised fifty-four females with normal hearing sensitivity who belonged to two groups. Group-I consisted of 27 individuals who underwent formal training in Bharatanatyam for a minimum period of three years. Group-II consisted of the age-matched control group, consisting of 27 individuals who were non-dancers. The auditory working memory tasks included arranging the English digits presented binaurally in forward, backward, ascending, and descending spans. The maximum values (for the length of sequence arranged), midpoint values (average score), and response time for each task were noted down and compared among groups. Results: The scores were compared using the Mann-Whitney U test, which revealed enhanced working memory exhibited by dancers for maximum values and midpoint scores for all three tasks except ascending span. It was also noted that the dancers exhibited a shorter response time compared to non-dancers for all the tasks except ascending span. Conclusion: The current study highlights an enhanced auditory working memory capacity in Bharatanatyam dancers, which could be perceived as evidence of neuroplastic changes induced in the auditory and motor cortex as a consequence of extensive stimulation for auditory processing abilities and motor planning resulting from long-term dance training and regular practice.