Post-Concussion Misophonia

The concussion causing brass bird

Source: Heather Finlay-Morreale

My husband over dinner: “Chew. Chew. Smack. Smack. Swallow. Swish. Grind. Clink.”

“Why are you chewing so loudly?!” I loudly gripe.

“It’s kale salad. You are making the same amount of noise I am.” He answers, aggravated.

As he chews, I hear “Slob-slob-sloberry sounds” filling my whole soundscape. Then my whole sensory landscape. I can see the saliva in my mind. I am pressed against the window in a car wash with rivers of mucus-ey saliva dripping down in front of my face.

My body screams “Flee! Flee! Escape!” As my heart races. I quickly slap my hands over my ears and yell “Stop that slop-slop-slobbering!” I can’t wait one second for him to stop, and bolt out of the room to get my noise-blocking headphones. Another dinner ruined.

I wasn’t always this way. Not until my concussion.

Last April I was laying on the floor putting a textbook on the bottom shelf of a floor-to-ceiling bookcase. There was a garland of wooden sea creatures dangling down from the very top of the shelf where it was hooked onto the tall graceful neck of a brass egret. The garland toppled down on me and the brass bird slammed into my head from a bit over 6 feet above.

At first, I was sensitive to all sounds. Even normal speech was booming. Loud sounds like alarms were intolerable. Over the next few months, the sensitivity to voices went back to normal. Beeping alarms were still aggravating and unpleasant, but no longer a cannon hitting my head. But eating sounds — hearing others eat remains excruciating. By an unknown mechanism, the initial hyperacousis after the concussion had transitioned to misophonia. Since it remains present over a year later, I suspect it is permanent.

Misophonia is common, affeccting about 3.2% of people.¹ Surveys of people with misophonia find sounds of eating, drinking, and breathing are the main triggers. Interestingly, the misophonic triggers are sounds similar to those made by people with Tourette’s Syndrome. And the reactions of misophonia sufferers (emotional, motor, speech, and autonomic arousal) are similar to the responses of people with obsessive-compulsive disorder. The typical responses to misophonia triggers are anger or aggravation, stress or anxiety, feeling trapped and impatient, and disgust. The sound is expressed as, or felt in, a different modality, or emotion, not unlike synesthesia. There are many pathways to misophonia. Some develop it idiopathically as children or adolescents. Others like myself are misophonic after a brain injury, others from noise or barometric damage. There is a relationship between hyperacousis and tinnitus and misophonia, and 60% of those with tinnitus also have misophonia.²

Misophonia has a negative impact on my life. It causes stress in my family. I am not generally in enough control to speak diplomatically while I am fleeing in disgust. My husband does not appreciate my describing his entirely typical eating as slobbering. I am leery of attending professional or family events where food is served, as my reaction is humiliating.

What’s going on in my brain during misophonic reactions? Am I actually perceiving quiet sounds as loud, as a subtype of hyperacousis, or am I simply oversensitive? Has my perception changed or my sensitivity? And can people’s perceptive ability change? Oliver Sacks described this occurring in The Man Who Mistook His Wife for a Hat.³ He presented the case of a medical student who took methamphetamines and had massively enhanced smell perception to the point where he could tell people apart by their smell. This was an overnight change, and not a slow adaptation. Is there an innate, but underused, perceptive ability in our brain? Or a different way of processing sensory information that can be accessed by drug use, brain injury, or changes to hearing? I always had strong hearing and even as a child would awaken to an animal in the backyard that did not awaken my family. Now I am distracted by ticking clocks on TV shows that no one else notices. So, there is an element of perception that appears to be enhanced after my concussion, but only gustatory sounds trigger the emotional response.

What is known about how the brain operates in people with misophonia versus controls? Kumar and Denys’ studies discussed in a Nature Scientific Reports paper⁴ both used fMRI and demonstrated that typical misophonic triggers cause activation of the anterior insula and abnormal signals to the hippocampus and amygdala. Controls do not have this, nor do either controls or misophonics react to aversive, but not gustatory stimuli—for example, violent imagery. Based on how I and other misophonics respond, it isn’t surprising that regions involved in emotion processing, regulation, and salience, are involved. Along with these brain changes, the same studies showed there is autonomic activation seen by increased heart rate and skin conductance. A measurable neurological and physiological process is occurring.

For now, my noise-blocking headphones are a lifesaver. But avoidance and isolation are not a solution. I can’t stop the world from eating.