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Handb Clin Neurol. 2015;129:375-87. doi: 10.1016/B978-0-444-62630-1.00021-4.

Decreased sound tolerance: hyperacusis, misophonia, diplacousis, and polyacousis.

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Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA, USA. Electronic address:
JHDF, Inc., Ellicott City, MD, USA.


Definitions, potential mechanisms, and treatments for decreased sound tolerance, hyperacusis, misophonia, and diplacousis are presented with an emphasis on the associated physiologic and neurophysiological processes and principles. A distinction is made between subjects who experience these conditions versus patients who suffer from them. The role of the limbic and autonomic nervous systems and other brain systems involved in cases of bothersome decreased sound tolerance is stressed. The neurophysiological model of tinnitus is outlined with respect to how it may contribute to our understanding of these phenomena and their treatment.


decreased sound tolerance; diplacousis; hyperacusis; limbic and autonomic nervous systems; misophonia; phonophobia; polyacousis; the neurophysiological model of tinnitus

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