Audiologists’ Q&A on Misophonia with Jenna Pellicori

Join us on January 28th at 7:00 PM EST for a Workshop “Misophonia and How It Relates To Other Disorders”. $75. Featuring Dr. Jenna Pellicori and Dr. Jennifer Jo Brout.

January 28th: Workshop, “How Misophonia Relates To Other Disorders”

Interview with Dr. Jenna Pellicori, Au.D. CCC-A

What does an audiologist do?

Audiologists are specialized healthcare professionals who identify, diagnose, and provide evidence-based treatment for hearing, balance, and other auditory disorders. Audiologists have a deep understanding of hearing, the auditory system, and acoustic properties of sound.

What help do you believe audiologists can offer for those suffering with Misophonia, especially (especially considering the lack of treatment and research available)?

Our primary goal is to differentiate Misophonia from other auditory or hearing-based disorders such as Tinnitus (ringing in the ears) or Hyperacusis (heightened sensitivity to sounds). It is important as audiologists that we are able to come to a differential diagnosis in order to provide the most appropriate intervention or management strategies for our patients.

Audiologists can also provide recommendations for sound therapy to help mask the trigger sounds and recommend tools that may be useful for the patient, such as noise-cancelling headphones or sound generators. Part of our role as audiologists also entails gathering clinical evidence in order to inform more formalized research.

How would you approach a patient with Misophonia? Do you recommend multidisciplinary specialists (a psychologist/psychiatrist, etc.)?

There is no cure for Misophonia and little research to support effective treatment. However, we are learning more and more each day. There are approaches and accommodations for which there is some reported success. However, there is no “quick-fix”, unfortunately. Coping skills and these specific approaches appear to take on a multidisciplinary approach. As Audiologists we often offer and encourage ways to modify sound in order to reduce or lessen the trigger response, and consequently the overall physiologic response.

Many sufferers of Misophonia wear earplugs around the clock – could you please recommend some “best practices” for earplug use?

Earplugs are designed to protect against loud or harmful sounds by blocking the ear canal so that sound vibrations are reduced by the time they reach the eardrum or inner ear. It’s important for users to determine if the earplugs they are using are disposable or reusable. As a general rule of thumb, most foam earplugs are meant for single use. You can also purchase custom ear molds from manufacturers that are often multi-use.

In regards to best practices for earplug use, here are a couple of helpful tips:

Clean or discard earplugs – you should clean custom or pre-molded earplugs regularly and discard of single-use earplugs. If you do not clean the earplugs or continue to use single use earplugs then you can introduce dirt or bacteria into the ear canal which can cause infections, hearing loss, and ear pain.
Your doctor should check for excessive earwax – if you are using earplugs or ear molds on a frequent basis, you should have your primary doctor occasionally check your ears for excessive cerumen (“ear wax”). A little bit of earwax is a good thing because it protects the ears from foreign objects, harmful bacteria, and it lubricates the ear canals. However, using earplugs too often can cause earwax build-up resulting in ear pain, temporary hearing loss, muffled hearing, tinnitus, unpleasant odors, and aural fullness. Excessive earwax can also deform or misshapen earplugs overtime, making them less efficient and altering their overall efficiency.
Try a lubricant if the molds are drying out or irritating your ears – Oto-ease is a sterile and water soluble lubricant that can help guide ear molds effortlessly into the ears. It ultimately helps with ease of insertion. It is especially helpful for custom molds, which are tight fitting or extend deeply into the canal.
Do your research – our ears and hearing are valuable, so before you go sticking “things” in your ears, you should do a little bit of self-education and research. Some individuals are allergic to certain types of ear mold materials, in which case they may benefit from medical grade silicone custom ear molds or an alternative material. In addition, earplugs often display a NRR (Noise Reduction Rating) or offer a variety of “acoustic filter” options.

NRR values provide insight into how efficient the earplugs are at reducing noise in decibels (a degree of loudness) or filtering out certain sounds while maintaining the clarity and quality of the auditory signal. As a general rule of thumb – higher NRR values are associated with greater levels of noise reduction. The highest NRR rating for earplugs is 33 but it is important to note that these ratings are not as straightforward as one would think… this does not mean that there is a 33 dB noise-reduction! That is why it is important to self-educate. You can learn more at The National Institute for Occupational Safety and Health, which will further clarify ratings and their potential for noise reduction.

Is using earplugs regularly dangerous? Or, do earplugs protect the ears in case of other damage?

I don’t want to be the bearer of bad news but wearing earplugs too frequently or for extended periods of time can actually heighten auditory sensitivity. Earplugs and noise-cancelling headphones are fantastic when they are used in the right way. If an individual feels that they need to block or mask out sounds for a prolonged period of time, then they should be encouraged to play environmental sounds, white noise, or music, in order to provide continual stimulation to the auditory system and prevent deprivation or heightened auditory sensitivity.

How often should one “throw out” their earplugs, and do you have any specialized earplugs that you would recommend? Is silicone better than foam? Is there a drawback to one or either?

This question depends on whether you are currently using single-use or multi-use earplugs. Most foam earplugs are meant for single-use use and have a short life span. It is recommended you discard of foam earplugs on a daily basis unless otherwise specified.

When used appropriately foam earplugs are generally considered safe for our ears. However, using foam earplugs more than directed can lead to bacteria in the ears resulting in infection, and also lessen the efficiency of the overall noise reduction properties. You also want to refrain from pushing foam earplugs too far into the ear canal, which can result in pain and discomfort.

With proper handling, custom ear molds will often last as long as 3-5 years. Custom silicone ear molds are often preferred and recommended for individuals who utilize ear molds on a more frequent basis.

It is hard to recommend specialized earplugs because they make earplugs and custom molds for a variety of reasons. Many of these earplugs and molds have different noise reduction ratings and/or acoustic filters depending on the patient’s unique needs and desire. A good starting point would be to look into the following manufacturers: Westone, Etymotic Research, and Mirosonic. These manufacturers are well known for their custom products. You can also consult with an audiologist or hearing healthcare professional in your area for additional information or advice.

How do Misophonia sufferers avoid damaging their ears when actively using noise generators or earplugs?

Listening to loud sounds for extended periods of time, can causes temporary and permanent issues such as tinnitus and noise-induced hearing loss. As a general rule of thumb, you do not want noise levels to exceed 85 dB for more than 8 hours at a time as this can put you at risk for hearing loss. As the intensity level exceeds 85 dB the exposure time decreases. You can learn more about protecting your hearing against loud noise exposure at The National Institute for Occupational Safety and Health.

On the ear-level sound generators are becoming a popular option for patients with Misophonia. These devices look like small hearing aids but are designed to provide access to pleasant or neutral auditory stimuli such as environmental sounds, white noise, pink noise, fractal tones, and music to help mask out all or part of the “trigger” sound. This is a discreet option that is worn on the ear and allows the patient to have access to “maskers” or “sound” at any point in the day.

As audiologists, we want to leave your ear as open as possible, and not plug them up, so you can still engage in conversations while attempting to mask out the aversive stimulus. We try to preserve as much of the speech intelligibility index as possible for our patients, so that they can participate in social interactions and do not feel the need to isolate themselves. Most on the ear level sound generators are programmed to have “maximum output levels”, which are designed to limit the output of the device, so you do not damage your residual or natural hearing.

What are the possible negative effects that can happen for sufferers that frequently wear headphones? Do you believe this could be making their ears more sensitive?

Hearing protection is very important in preventing damage to our cochlea, the organ of hearing, when used appropriately. However, there is a great deal of research that does show overprotecting your ears by wearing earplugs or noise-cancelling headphones too frequently can result in auditory hypersensitivity or exacerbate hyperacusis. This has not been specifically researched in patients with Misophonia. However, because both misophonia and hyperacusis are related to decreased sound tolerance, it is logical to be concerned with the abovementioned problems with over protection. This is not meant to discourage the use of hearing protection, earplugs, or noise-cancelling headphones in the appropriate contexts because exposure to loud sounds over extended periods of time without hearing protection can result many auditory and hearing problems.

Are there certain headphones you recommend for patients that would be using headphones regularly?

I have heard great things about the Bose QuietComfort 35 (Series II) and Apple’s Beats Studio 3 Wireless noise-cancelling headphones. Remember if you are going to wear headphones frequently,then you should attempt to play environmental sounds, white noise, or music, in order to provide continual stimulation to the auditory system in order to prevent deprivation or heightened auditory sensitivity.

Does wearing earplugs with headphones mitigate damage that can be done to the ears from regular music/headphone usage?

You can increase the efficiency of hearing protection by utilizing headphones over earplugs in an attempt to further attenuate sound; however, this is typically not considered best practice unless you have been directed by a hearing conservation program or professional to do so (in order to protect against loud-noise exposure to protect your hearing).

If you are concerned about volume regulation and damaging your hearing, there are headphones and ear buds out there that have volume-limiting features to help prevent against noise-induced hearing loss. However, it is important to research products, as many volume-limiting devices often exceed the decibel level advertised. In addition, there may be ways to bypass the volume reduction feature on many of the headphone sets making them ineffective. If you are listening to music or auditory input at a safe and “comfortable” level, then there is typically no reason to use earplugs in addition to headphones to mitigate damage.

Jenna M Pellicori-Curry, Au.D., CCC-A, received her Bachelor’s Degree from James Madison University. She continued to receive her Doctorate degree and Biomedical Sciences Concentration from Salus University. Dr. Pellicori graduated as valedictorian of her doctoral program and currently serves as the lead audiologist at Nemours/Alfred I duPont Hospital for Children’s New Jersey satellite locations. Dr. Pellicori is licensed to practice audiology in New Jersey, Pennsylvania, and Delaware, and she holds a hearing aid dispensing license for the state of New Jersey. She continues to maintain her Certificate of Clinical Competence from the American Speech-Language-Hearing Association.