Misophonia update It has been theorized that the

Misophonia update • It has been theorized that the structures of the brain involved with fight or flight are activated by the trigger sounds of misophonic patients.

The Brain Basis for Misophonia Kumar, Tansley-Hancock, Sedley, Winston, Callaghan, Allen, Cope, Gander, Bamiou, and Griffiths Current Biology, February 20, 2017 • f. MRI studies have confirmed that trigger sounds elicited and exaggerated response in the area of the Anterior insular cortex (AIC) and a network of regions that are responsible for emotional processing.

These include: • Ventromedial prefrontal cortex • Posteromedial cortex • Hippocampus • Amygdala

Trigger sounds elicited • Increased heart rate • Galvanic skin responses • These are typical of the fight or flight response

Final finding • Brain structure measurements implied greater myelination within the ventromedial prefrontal cortex

These results confirm what has been theorized by professionals treating misophonia. • Is this • • • A structural issue Metabolic issue Psychologic issue Audiologic issue Combination issue • This is still to be decided

How does this help treatment • We now know that we were on the right track to treat the process that impacted the fight of flight type responses. • This is not the cure but the bandage at this point.

OTC information

Some numbers ➤ 40 million with hearing loss in USA ➤ 10% of mild to moderate hearing loss diagnosed and treated ➤ 60% start at PCP offices, 15% screen patients in some way ➤ 30% start with ENT offices ➤ 10% start with audiologists and HAD

Acronyms §NASEM – national academies of science and medicine §PCAST – president’s council on science and technology §CTA – Consumer Technology Association (BOSE, APPLE, etc. ) §PSAP – personal sound amplification products

Disruptive Industries • Examples: • ➤Microsoft • ➤Apple • ➤Internet sales • ➤Amazon • ➤Audiologists allowed to dispense by ethical standards

OTC Status §House passed the bill §Senate passed the bill §President signed it into law 8/19/17 §Manufacturers foot the bill for the program §FDA is now funded through 2022 §FDA has up to 3 years to implement §Expected to be fast tracked, however §Then what?

What needs to be decided? What State legislative actions are needed? §Who will be selling them? §Who will be programming them? §How do they compete against traditional aids? §Who will be servicing them? §How effective will they be? §How will this impact my income? §What do we need to do to capitalize on this? §Should you proactively mention OTC to patients?