Hearing Disorders

听力障碍
  • 文章类型: Journal Article
    这项横断面研究旨在解决中国听力障碍(HI)青少年在了解体重指数(BMI)与身体素质水平之间关系方面的关键差距。这项研究调查了不同BMI水平如何影响HI青少年的体质指数(PFI)。
    这项研究对参加特殊教育学校的HI青少年进行了体能测试。测试包括八个组成部分:高度,体重,50米冲刺,站立跳远,坐下来,伸手去拿,耐力跑,屈膝仰卧起坐(女孩),和引体向上(男孩)。每个学生的考试成绩按年龄和性别进行标准化。然后计算个人Z分数,这些Z分数的总和构成PFI。采用Logistic回归分析不同性别、年龄组BMI与PFI的关系。P<0.05时具有统计学意义。
    线性回归模型显示BMI与PFI之间呈倒U型关系。在相同的BMI水平下,与BMI相同的女孩相比,男孩表现出更好的身体素质(P<0.05)。正常体重和肥胖男性之间的PFI水平存在统计学上的显着差异,以及体重不足和肥胖男孩之间(P<0.05)。在13-15岁和16-18岁年龄组中,BMI的增加对男孩PFI的影响大于对女孩的影响。
    患有HI的青少年通常表现出良好的身体素质。与体重正常的人相比,那些体重不足的人,超重,或肥胖表现出较低的体能水平。未来的干预措施应侧重于BMI异常的HI青少年。
    UNASSIGNED: This cross-sectional study aimed to address a critical gap in the understanding of the association between body mass index (BMI) and physical fitness levels in adolescents with hearing impairment (HI) in China. This study investigated how different BMI levels impact the physical fitness index (PFI) of HI adolescents.
    UNASSIGNED: This study employed a physical fitness test for HI adolescents attending special education schools. The test included eight components: height, weight, 50-m sprint, standing long jump, sit and reach, endurance run, bent-knee sit-up (for girls), and pull-up (for boys). Test scores for each student were standardized by age and gender. Individual Z-scores were then calculated, and the sum of these Z-scores constituted the PFI. Logistic regression was used to analyze the relationship between BMI and PFI across different gender and age groups. Statistical significance was set at P < 0.05.
    UNASSIGNED: The linear regression model showed an inverted U-shaped relationship between BMI and PFI. At the same BMI level, boys exhibited superior physical fitness compared to girls with the same BMI (P < 0.05). Statistically significant differences in PFI levels were observed between normal-weight and obese males, as well as between underweight and obese boys (P < 0.05). In the 13-15 and 16-18 age groups, the increase in BMI has a greater impact on boys PFI than on girls.
    UNASSIGNED: Adolescents with HI generally demonstrated good physical fitness. Compared to individuals with normal weight, those who were underweight, overweight, or obese exhibited lower levels of physical fitness. Future interventions should focus on adolescents with HI with abnormal BMI.
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  • 文章类型: Journal Article
    在他们的工作中,教师可能会受到导致不同健康问题的条件。这项研究调查了858名教师(528名女性;年龄44.0±9.67岁)的代表性样本中的职业健康失调,分为三组具有特定职业要求的教师:专业体育教师(专业PETs),课堂教师,和专业教师。使用慢性健康障碍问卷记录过去12个月的健康障碍数量。不同类型教师之间的差异,控制性别和年龄,采用二元逻辑回归分析。结果显示,89%的教师患感冒是最常见的健康问题,其次是58%的下背部问题,57%的头痛,51%为声音嘶哑,43%的脖子问题。二元逻辑回归显示,专业PETs是健康风险最高的组。他们患肌肉骨骼或听力障碍的可能性是其他两组教师的两倍。他们也更有可能患有声音嘶哑。了解这些不同的健康挑战对于开发有针对性的干预措施和强大的支持系统至关重要。这些干预措施应包括旨在提高对健康风险因素的认识的举措,实施损伤干预措施和声带卫生计划,进行人体工程学调整,和促进自我保健意识(精神和身体)。鉴于目前教师职业正在努力应对劳动力老化和教师短缺的问题,解决这些挑战对教学专业人员的持续福祉至关重要。
    During the course of their work, teachers may be subjected to conditions that cause different health problems. This study examines occupational health disorders in a representative sample of 858 teachers (528 female; age 44.0 ± 9.67 years) divided into three groups of teachers with specific occupational requirements: specialist physical education teachers (specialist PETs), classroom teachers, and specialist teachers. The number of health disorders in the last 12 months was recorded using the Chronic Health Disorders Questionnaire. The differences between the different types of teachers, controlled for sex and age, were analyzed using binary logistic regression. The results showed that 89% of teachers experienced colds as the most frequently reported health problem, followed by 58% for lower back problems, 57% for headaches, 51% for hoarseness, and 43% for neck problems. A binary logistic regression showed that specialist PETs were the group with the highest health risk. They were about twice as likely to have musculoskeletal or hearing disorders than the other two groups of teachers. They were also significantly more likely to suffer from hoarseness. Understanding these different health challenges is critical to developing targeted interventions and robust support systems. These interventions should include initiatives aimed at raising awareness of health risk factors, implementing injury interventions and vocal cord hygiene programs, making ergonomic adjustments, and promoting awareness of self-care (both mental and physical). Given that the teaching profession is currently struggling with an aging workforce and a shortage of teachers, addressing these challenges is critical to the continued well-being of the teaching professionals.
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  • 文章类型: Journal Article
    背景:老年人的感觉障碍与认知功能下降有关,抑郁症状升高,和低水平的生活满意度。然而,这些关系通常是分开和成对的。这项研究全面检查了这些关系,第一次。
    方法:分析包括来自中国健康与退休纵向研究的5,658名社区居住的老年人(年龄在50至108岁之间,52.1%的男性)完成了Jorm线人问卷的老年人认知下降和流行病学研究中心-抑郁症-简表。问卷被用来收集听力信息,视觉状态,和生活满意度。结构方程模型用于检查这些变量之间的直接和间接关系。
    结果:自我报告的听力和视力问题与认知能力下降和抑郁症状升高直接相关。此外,听力和视力问题通过升高的抑郁症状与认知能力下降间接相关。尽管听力和视力问题对生活满意度没有直接影响,它们通过认知功能下降和抑郁症状与生活满意度间接相关.
    结论:这项研究为听力和视力问题之间的全面关系提供了第一个流行病学证据。认知能力下降,抑郁症状,和生活满意度。当老年人报告听力和/或视力问题时,临床医生和护理人员应该意识到认知下降的并发,抑郁症状升高,并补偿生活满意度。未来的研究应该检查因果关系和这些关系的潜在机制。
    BACKGROUND: Sensory impairment in older adults is associated with cognitive decline, elevated depressive symptoms, and low levels of life satisfaction. However, these relationships are usually investigated separately and in pairs. This study examined these relationships comprehensively, for the first time.
    METHODS: The analysis included 5,658 community-dwelling older adults from the China Health and Retirement Longitudinal Study (aged 50 to 108 years, 52.1% male) who completed the Jorm Informant Questionnaire Cognitive Decline in the Elderly and the Center for Epidemiological Studies-Depression-short form. A questionnaire was used to collect information on hearing, visual status, and life satisfaction. Structural equation modelling was used to examine the direct and indirect relationships between these variables.
    RESULTS: Self-reported hearing and vision problems are directly associated with cognitive decline and elevated depressive symptoms. In addition, hearing and vision problems are indirectly related to cognitive decline through elevated depressive symptoms. Although hearing and vision problems had no direct effect on life satisfaction, they were indirectly associated with life satisfaction through cognitive decline and depressive symptoms.
    CONCLUSIONS: This study provides the first epidemiological evidence of the comprehensive relationships between hearing and vision problems, cognitive decline, depressive symptoms, and life satisfaction. When older adults report hearing and/or vision problems, clinicians and caregivers should be aware of the concurrence of declined cognition, elevated depressive symptoms, and compensated life satisfaction. Future studies should examine the causal relationships and potential mechanisms of these relationships.
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  • 文章类型: Journal Article
    误音之间的关系,压力,创伤压力还没有得到很好的科学表征。本研究旨在探讨音差之间的关系,压力,一生的创伤事件,和创伤压力。社区样本中的成年人自我报告的错音(N=143)完成了结构化的诊断访谈和心理测量验证的自我报告措施。在感知压力之间观察到显著的正相关,创伤性压力,和混音严重程度。然而,多变量分析显示,感知压力显着预测错音严重程度,超过创伤压力症状。不良生活事件的数量与错音严重程度无关。在创伤后应激障碍的症状群中,只有过度唤醒与错音严重程度相关.这些发现表明,与压力有关的诊断过程,比如感知到的压力和过度唤醒,可能是重要的表型特征和可能的治疗目标的成人与声音。
    The relationship between misophonia, stress, and traumatic stress has not been well characterized scientifically. This study aimed to explore the relationships among misophonia, stress, lifetime traumatic events, and traumatic stress. A community sample of adults with self-reported misophonia (N = 143) completed structured diagnostic interviews and psychometrically validated self-report measures. Significant positive correlations were observed among perceived stress, traumatic stress, and misophonia severity. However, multivariate analyses revealed that perceived stress significantly predicted misophonia severity, over and above traumatic stress symptoms. The number of adverse life events was not associated with misophonia severity. Among symptom clusters of post-traumatic stress disorder, only hyperarousal was associated with misophonia severity. These findings suggest that transdiagnostic processes related to stress, such as perceived stress and hyperarousal, may be important phenotypic features and possible treatment targets for adults with misophonia.
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  • 文章类型: Journal Article
    氯喹及其类似物羟基氯喹是4-氨基喹啉的衍生物,经常用于治疗疟疾和自身免疫性疾病。在这些药物的副作用中,经常提到与听觉系统相关的改变。因此,本系统综述的目的是系统综述有关听力障碍和氯喹或羟氯喹使用的出版物.
    纳入标准是对使用氯喹或羟氯喹的参与者进行听力学评估的观察性或介入性研究。方法质量由两名评审员使用统计学的Meta分析:评估和审查工具独立评估。使用GRADE工具评估证据的确定性。
    共筛选了1372篇非重复论文,其中17个被包括在最终的定性综合中,和5项研究的荟萃分析。评估的两个亚组的比值比没有显示出显著性,在不同疾病之间观察到的效应之间没有异质性(I2=0%),并获得0.76的全局估计值(95%置信区间[CI]=0.41-1.39;p>0.05)。尽管包含了不同疾病样本的论文,在分析中观察到的异质性较低(I2=0%),预测区间(95%PI=0.32-1.80;p>0.05)仍接近CI估计的(95%CI=0.41-1.39;p>0.05).由于存在偏差的风险,GRADE工具评估的证据的确定性被认为非常低,间接证据,和不精确。
    这项研究的结果表明,使用氯喹/羟氯喹与听力障碍无关。
    OBJECTIVE: Chloroquine and its analog hydroxychloroquine are derivatives of 4-aminoquinoline and are regularly used in the treatment of malaria and autoimmune diseases. Among the side effects of these drugs, alterations associated with the auditory system are frequently mentioned. Thus, the aim of this systematic review is to systematically review publications on hearing disorders and chloroquine or hydroxychloroquine use.
    METHODS: Inclusion criteria were observational or interventional studies on audiological assessment in participants who were using chloroquine or hydroxychloroquine. The methodological quality was independently assessed by two reviewers using the Meta-Analysis of Statistics: assessment and review Instrument. The certainty of the evidence was assessed using the GRADE tool.
    RESULTS: A total of 1,372 non-duplicate papers were screened, out of which 17 were included in the final qualitative synthesis, and 5 studies in the meta-analysis. The odds ratio for the two subgroups evaluated did not show significance with no heterogeneity between the effects observed between the different diseases (I2=0%) and obtaining the global estimate of 0.76 (95% confidence interval [CI]=0.41-1.39; p>0.05). Despite the inclusion of papers with different disease samples, the heterogeneity observed in the analysis was low (I2= 0%) and prediction interval (95% PI=0.32-1.80; p>0.05) remained close to that estimated by the CI (95% CI=0.41-1.39; p>0.05). The certainty of the evidence assessed by the GRADE tool was considered very low due to the risk of bias, indirect evidence, and imprecision.
    CONCLUSIONS: The findings of this study suggest that the use of chloroquine/hydroxychloroquine is not associated with hearing disorders.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Journal Article
    背景和目的:个体报告在感染SARS-CoV-2(COVID-19)后持续症状持续超过4周(长COVID综合征)。据报道,长发COVID症状中有头晕和听力损失。然而,对长期COVID患者头晕和听力损失的潜在预测因素知之甚少。这项研究旨在探索长期COVID综合征患者样本中头晕和听力损失的存在及其相关性。材料和方法:研究开始前至少8周感染COVID-19的年龄在18岁及以上的个体,如果他们在感染COVID-19之前未被诊断为头晕或听力损失,则纳入研究。收集人口统计和COVID-19相关信息。参与者完成了头晕障碍清单(DHI),特定活动平衡置信度(ABC)量表,国际跌倒疗效量表(FES-I),修正疲劳冲击量表(MFIS),和医学结果研究简表12(SF-12)。最后,在一个子样本中使用纯音测听法(PTA)评估听力.结果:平均(SD)年龄为27(9)的两百零九个人(66%为女性)参加了研究。在26和15.3%的样本中报告了感觉到的头晕和听力损失,分别。进行Logistic回归以分别确定头晕和听力损失的潜在预测因子。在控制了头晕的年龄和严重程度后,女性和高度疲劳与报告头晕的可能性增加相关(R2=31%).COVID-19急性期头晕和神经系统症状的严重程度与控制年龄后报告听力损失的可能性增加相关(R2=10.4%)。结论:长发COVID患者存在头晕和听力损失,并可能致残。应询问高度疲劳的女性持续头晕。对于长期COVID导致的神经系统症状和严重头晕的个体,应考虑听力损失。
    Background and Objectives: Individuals report persistent symptoms after becoming infected by SARS-CoV-2 (COVID-19) that last for >4 weeks (long-COVID syndrome). Dizziness and hearing loss have been reported among long-COVID symptoms. However, little is known about the potential predictors of dizziness and hearing loss in individuals with long COVID. This study aimed to explore the presence and correlates of dizziness and hearing loss in a sample of people with long-COVID syndrome. Materials and Methods: Individuals aged 18 years and older who were infected with COVID-19 at least 8 weeks prior to the start of the study were included if they were not diagnosed with dizziness or hearing loss before getting COVID-19. Demographics and COVID-19-related information were collected. Participants completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence (ABC) scale, Falls Efficacy Scale International (FES-I), Modified Fatigue Impact Scale (MFIS), and Medical Outcomes Study Short Form 12 (SF-12). Finally, hearing was assessed using pure-tone audiometry (PTA) in a subsample. Results: Two hundred and nine individuals (66% female) with a mean (SD) age of 27 (9) participated in the study. Perceived dizziness and hearing loss were reported in 26 and 15.3% of the sample, respectively. Logistic regression was conducted to identify potential predictors of dizziness and hearing loss separately. After controlling for age and severity of dizziness, female sex and high fatigue severity were associated with an increased likelihood of reporting dizziness (R2 = 31%). The severity of dizziness and neurological symptoms during the acute stage of COVID-19 were associated with an increased likelihood of reporting hearing loss (R2 = 10.4%) after controlling for age. Conclusions: Dizziness and hearing loss present in long COVID and can be disabling. Females with high levels of fatigue should be questioned about persistent dizziness. Hearing loss should be considered in individuals with neurological symptoms and severe dizziness as a consequence of long COVID.
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  • 文章类型: Journal Article
    目的:检查视力和听力问题的变化是否与心理社会结果的变化有关(就抑郁症状而言,孤独,和感知到的社会孤立)。
    方法:我们使用了具有全国代表性的德国老龄化调查的纵向数据,涵盖43岁及以上的个体(第6波和第7波,有7108个观测值,平均年龄为67.5岁,SD10.2年)。6个项目的DeJongGierveld工具用于量化孤独感,Bude和Lantermann工具被用来量化感知的社会孤立,和流行病学研究中心抑郁量表(15项版本)用于量化抑郁症状。由于视力问题而导致的阅读报纸的自我评估问题以及由于视力问题而导致的认识街上的人的自我评估困难被用来量化视力问题。此外,使用电话自评听力问题和四人以上小组的自评听力问题来量化听力问题。
    结果:调整各种混杂因素,纵向回归显示,主要视力问题的出现是指在街上认识的人的困难与孤独感(β=0.17,p<.01)和抑郁症状(β=1.90,p<0.05)的增加有关。此外,一些视力问题的出现与阅读报纸的困难有关,这与感知的社会孤立感的增加有关(β=0.06,p<0.01)。此外,在4人以上的人群中,一些听力问题的出现与抑郁症状的增加有关(β=0.43,p<0.05)。
    结论:我们的纵向研究表明,视力和听力问题对心理社会因素的影响不同。延迟感觉障碍可能会在以后的生活中导致有利的心理社会因素。
    OBJECTIVE: To examine whether changes in vision and hearing problems are associated with changes in psychosocial outcomes (in terms of depressive symptoms, loneliness, and perceived social isolation).
    METHODS: We used longitudinal data from the nationally representative German Ageing Survey, which covers individuals aged 43 years and over (wave 6 and wave 7, with 7108 observations and mean age of 67.5 years, SD 10.2 years). The 6-item De Jong Gierveld tool was used to quantify loneliness, the Bude and Lantermann tool was used to quantify perceived social isolation, and the Center for Epidemiologic Studies Depression Scale (15-item version) was used to quantify depressive symptoms. Self-rated problems reading the newspaper due to vision problems and self-rated difficulties recognizing known people on the street due to vision problems were used to quantify vision problems. In addition, self-rated hearing problems on the telephone and self-rated hearing problems in groups of more than four people were used to quantify hearing problems.
    RESULTS: Adjusting for various confounders, longitudinal regressions showed that the onset of major vision problems referring to difficulties recognizing people one knows on the street was associated with increases in loneliness (β = 0.17, p < .01) and depressive symptoms (β = 1.90, p < 0.05). Moreover, the onset of some vision problems referring to difficulties reading the newspaper was associated with increases in perceived social isolation (β = 0.06, p < 0.01). Additionally, the onset of some hearing problems in groups of more than four people was associated with increases in depressive symptoms (β = 0.43, p < 0.05).
    CONCLUSIONS: Our longitudinal study showed that vision and hearing problems can contribute differently to psychosocial factors. Delaying sensory impairment may result in favorable psychosocial factors in later life.
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  • 文章类型: Journal Article
    目的:本研究旨在确定术前抑郁,压力,和人格因素影响人工耳蜗(CI)术后生活质量(QOL)。
    方法:在这项前瞻性研究中,术前和术后12个月对79例接受CI手术的患者进行了评估。通过奈梅亨人工耳蜗植入问卷(NCIQ)评估疾病特异性生活质量,并通过WHOQOL-BREF评估一般生活质量。使用患者健康问卷(PHQ-D)评估压力和压力。Charlson合并症指数(CCI)用于对合并症进行分类。大五人格测验(B5T)用于评估基本人格维度。通过弗莱堡单音节测试在安静的情况下评估了言语理解,并通过奥尔登堡句子测试在噪音中评估了言语理解。
    结果:CI手术后,NCIQ总分明显改善(Δ17.1±14.7,p<0.001)。常规QOL(WHOQOL-BREF,Δ0.4±9.9,p=0.357),应力(Δ0.25±3.21,p=0.486),抑郁(Δ0.52±3.21,p=0.121)不受CI手术的影响。无抑郁(p<0.01)或应激(p<0.001)的患者总NCIQ评分明显较好。多元回归分析的结果表明,在适应了CCI,个性,年龄,和心理健康压力(β=-0.495,p<0.001)与术后NCIQ结果评分显著相关。抑郁和神经质对一般QOL的影响最大(β=-0.286和β=-0.277,p<0.05)。
    结论:压力症状和人格特质是疾病特异性生活质量的重要预测因素,以及听力状态。在术前咨询和优化康复过程中应考虑这一点。
    OBJECTIVE: This study aimed to determine whether preoperative depressiveness, stress, and personality influence quality of life (QOL) after cochlear implant (CI) surgery.
    METHODS: In this prospective study, 79 patients undergoing CI surgery were evaluated preoperatively and 12 months postoperatively. Disease-specific QOL was assessed with the Nijmegen Cochlear Implant Questionnaire (NCIQ) and general QOL with the WHOQOL-BREF. Depressiveness and stress were assessed with the Patient Health Questionnaire (PHQ-D). The Charlson Comorbidity Index (CCI) was used to classify comorbidities. The Big Five Personality Test (B5T) was used to assess the basic personality dimensions. Speech comprehension was evaluated in quiet with the Freiburg monosyllable test and in noise with the Oldenburg sentence test.
    RESULTS: After CI surgery, the total NCIQ score improved significantly (Δ 17.1 ± 14.7, p < 0.001). General QOL (WHOQOL-BREF, Δ 0.4 ± 9.9, p = 0.357), stress (Δ 0.25 ± 3.21, p = 0.486), and depressiveness (Δ 0.52 ± 3.21, p = 0.121) were unaffected by CI surgery. Patients without elevated depressiveness (p < 0.01) or stress (p < 0.001) had significantly better total NCIQ scores. The results of the multiple regression analyses show that, after adjusting for the CCI, personality, age, and mental health stress (ß = - 0.495, p < 0.001) was significantly associated with postoperative NCIQ outcome scores. Depressiveness and neuroticism had the strongest influence on the generic QOL (ß = - 0.286 and ß = - 0.277, p < 0.05).
    CONCLUSIONS: Stress symptoms and personality traits are significant predictive factors for disease-specific QOL, as well as hearing status. This should be considered in the preoperative consultation and in optimizing the rehabilitation process.
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  • 文章类型: Journal Article
    背景:杂音是最近发现的一种情况,在这种情况下,一个人感知到微妙的刺激(例如,吃的声音,头发旋转)并具有强烈的,负面情绪反应。杂音不能用已建立的杂音系统进行分类。方法:我们从认知行为框架中提出了一种新的声音错音的五阶段模型。该模型将自主神经系统的习得性反射确定为主要病因和维持音差。第一阶段是预期的焦虑和回避。第二阶段是条件反射(例如,小腿肌肉的紧张)通过刺激反应巴甫洛夫调节而发展。第三阶段包括强烈的负面情绪反应和伴随的生理困扰,思想,催促,和情绪驱动的行为。第四阶段是个体对情绪困扰的应对反应,第五阶段是应对行为的环境反应和由此产生的内部和外部后果。每个阶段都有助于解释反应的维持和个人的损害。结果:预期的焦虑和第一阶段的回避有助于提高唤醒和对触发因素的认识,导致触发体验的严重程度增加。第二阶段的巴甫洛夫条件反射和第三阶段的条件性情绪反应引起的情绪驱动行为都随着体内暴露于触发器而增加。第四阶段包括对强烈情绪和痛苦的内部和外部应对行为,第五阶段包括这些行为的后果。内部后果包括信念五和基于对愤怒和恐慌的环境反应的新情绪。例如,羞耻和内疚等情绪的发展,以及关于触发器有多“无法忍受”的信念。结论:我们断言错音是一种多感觉状态,包括预期的焦虑,有条件的身体反射,强烈的情绪和身体困扰,随后的内部和外部响应,和环境后果。
    Background: Misophonia is a recently identified condition in which a person perceives a subtle stimulus (e.g., eating sounds, hair twirling) and has an intense, negative emotional response. Misophonia cannot be classified with established nosological systems. Methods: We present a novel five-phase model of misophonia from a cognitive-behavioral framework. This model identifies a learned reflex of the autonomic nervous system as the primary etiology and maintenance of misophonia. Phase one is anticipatory anxiety and avoidance. Phase two is a conditioned physical reflex (for example, the tensing of calf muscles) that develops through stimulus-response Pavlovian conditioning. Phase three includes intense negative emotional responses and accompanying physiological distress, thoughts, urges, and emotion-driven behavior. Phase four is the individual\'s coping responses to emotional distress, and phase five is the environmental response and resulting internal and external consequences of the coping behaviors. Each phase helps explain the maintenance of the response and the individual\'s impairment. Results: Anticipatory anxiety and avoidance of phase one contributes to an increased arousal and awareness of triggers, resulting in increased severity of the trigger experience. Both the Pavlovian-conditioned physical reflex of phase two and the emotion-driven behavior caused by the conditioned emotional response of phase three increase with in vivo exposure to triggers. Phase four includes internal and external coping behaviors to the intense emotions and distress, and phase five includes the consequences of those behaviors. Internal consequences include beliefs fiveand new emotions based on environmental responses to anger and panic. For example, the development of emotions such as shame and guilt, and beliefs regarding how \'intolerable\' the trigger is. Conclusions: We assert misophonia is a multi-sensory condition and includes anticipatory anxiety, conditioned physical reflexes, intense emotional and physical distress, subsequent internal and external responses, and environmental consequences.
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