Linking misophonia and tinnitus: Common and divergent neurobiological mechanisms

Misophonia and tinnitus are debilitating auditory disorders that impair social functioning and mental health. This is the first review paper examining their common and divergent neurobiological underpinnings, focusing on genetic, neural, and psychological factors. Both conditions show hereditary influences, neural activity imbalances across the auditory cortex, amygdala, and anterior cingulate cortex, and heightened autonomic responses, causing significant distress and cognitive deficits. Misophonia is triggered by specific external sounds, while tinnitus involves phantom sound perception. Neuroimaging studies reveal shared hyperconnectivity between the auditory cortex and limbic areas of the brain including the amygdala and hippocampus, driven by neuroplasticity. Here, we propose the Sensory-Salience Dysregulation Model, integrating aberrant sensory encoding, salience network overactivation, and autonomic dysregulation as a unified framework between these conditions. The present review discusses gaps in diagnostic standardization and/or genetic-environmental interactions, and highlights shared and distinct mechanisms underlying misophonia and tinnitus, aiming to advance knowledge for improving diagnostics and treatments for these conditions.