A spirited scientific exchange in Audiology Research has reignited a central question for clinicians: should hyperacusis and misophonia be understood through the ear or the mind?

📄 Our paper: Psychiatric Comorbidities in Hyperacusis and Misophonia: A Systematic Review
https://www.mdpi.com/2039-4349/15/4/101

💬 Commentary: Professor Pawel Jastreboff’s Response
https://www.mdpi.com/2039-4349/15/6/146

🧭 Our reply: Comorbid Anxiety and Depression in Hyperacusis and Misophonia – Reply to Jastreboff
https://www.mdpi.com/2039-4349/15/6/147

In our original paper, we examined the evidence linking sound intolerance with psychiatric comorbidities such as anxiety and depression. Professor Jastreboff challenged this interpretation, arguing that by such reasoning, even conditions such as cancer would be classified as mental disorders.

In our published reply, we clarified that depression associated with physical illness still requires treatment, and adjustment disorder remains a psychiatric diagnosis warranting onward referral to psychology or psychiatry. We also emphasised the need to distinguish between reactive and primary (endogenous) depression—each requiring a different clinical pathway—to ensure that emotional distress is neither overstated nor dismissed.

This debate highlights the evolving role of audiologists in sound intolerance care. Audiologists are uniquely placed to screen for anxiety and depression, provide therapy for distress directly linked with hyperacusis and misophonia, and ensure appropriate onward referral to psychological services when indicated.

Through its structured training and clinical model, CBT Hear empowers audiologists to differentiate the distress caused by hyperacusis and misophonia from that arising from an underlying psychiatric condition—applying CBT-Hear techniques to treat the former and referring to mental-health professionals for the latter.

🔓 All three papers are open access, with free full-text PDFs available to read and share.