1. 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.

2. The Brain Basis for Misophonia Kumar, Tansley-Hancock, Sedley, Winston, Callaghan, Allen, Cope, Gander, Bamiou, and Griffiths Current Biology, February 20, 2017
fMRI 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.

3. These include: Ventromedial prefrontal cortex Posteromedial cortex
Hippocampus
Amygdala

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

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

6. 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

7. 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.

8. OTC information

9. 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

10. 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

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

12. President signed it into law 8/19/17
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?

13. 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?