Bruschetta Isn’t the Cure: Misophonia, Sensory Respect, and the Limits of Exposure

TL;DR:

I’m an autistic audiologist with personal experience of sensory overload, and I approach misophonia from a place of lived empathy. Instead of forcing exposure to triggers, I reduce the sensory load using low-gain hearing aids, customized sound shaping, and patient-controlled programs. It's not about tolerating what hurts... it’s about creating safety so people can function and choose when to engage. I offer real-world trials, not sales pitches, and I work virtually across states to meet people where they are. If you’ve ever hated a raw tomato and been told to just keep eating them, you’ll understand my approach. You don’t have to swallow what doesn’t sit right.

A Tomato Is Not Just a Tomato

I might be a professional audiologist, but I’m also an autistic adult with sensory issues. My reactions to certain textures and sounds aren’t just mild annoyances. They’re full-body responses that override logic, language, and even basic politeness. One of the clearest examples for me is raw tomatoes. I’m fine with them cooked. I like salsa. But raw? I can’t stand them.
The slick outer skin, the sudden shift to that watery, slimy interior... it makes my skin crawl. Every so often, someone will offer me some fancy tomato toast with olive oil and herbs, thinking that’ll change something. Maybe I can get it down, but I’m not okay. The texture hijacks my nervous system.

It makes me think of that old musical, Attack of the Killer Tomatoes. That’s exactly what it feels like. Not a small annoyance. Not picky eating. A full-on assault. Except the villain isn’t a monster. It’s a slice of fruit.

It’s not a phobia. I’m not afraid of tomatoes. I just hate them. And if you asked me to eat a bite of raw tomato every day to “build tolerance,” I wouldn’t improve. I’d get more resistant. More irritated. But if I’m in the right headspace, with no pressure, no spotlight, and plenty of other options, maybe I’d try it again. On my terms.

And the truth is, I don’t think I’ll ever like raw tomatoes, no matter how much bruschetta I eat. Maybe one day I’ll tolerate them more, but I’m just not in that headspace yet. And that’s just fine. I can coexist with them. But I don’t have to swallow them.
That’s how I approach misophonia.

Sensory Issues and Lived Empathy

It might be because of those sensory issues that I’m so interested in misophonia, hyperacusis, and auditory processing. I understand what it’s like to live in a body that doesn’t filter sound the way other people expect. I understand how quickly one small trigger can take over your whole day, or your whole life.

So when I treat misophonia, I start with a treatment trial. Always. Whether it’s therapy or technology, I have to know if it’s actually helping. Families shouldn’t be forced to pay thousands of dollars up front for something that might not work. That’s not just unfair. It’s harmful. And honestly, if we believe in what we’re doing, we should be willing to risk our own time first. If it helps, we keep going. If it doesn’t, we stop. That’s ethical care.

Why I Don’t Use Exposure Therapy

I’ve reached out to a few people who do exposure therapy for misophonia, and they’ve never written back. So while I stand to be corrected, I have to rely on what I’ve read and observed. From where I sit, exposure therapy for misophonia isn’t done in real-world environments. It doesn’t offer real protection. Maybe the person gets passive headphones. That’s about it. The goal seems to be increasing tolerance. Training the brain to accept more and react less. But that’s not how I approach it.
I don’t try to get people to tolerate what they find intolerable. I don’t push triggers to build resistance. I’m not trying to get people to “sit with” discomfort until it fades. I want to reduce the sensory load so their nervous system can actually settle. That’s not the same thing.
Exposure therapy, as I understand it, is often structured like a ladder. Start small, build up. But it can feel like being chased around with thumbtacks. Even if you say it’s therapeutic, the body says danger. It might work for some. But for others, especially those of us with strong sensory processing differences, it can retraumatize instead of help.

How I Use Hearing Aids for Misophonia

What I do is different. I use low-gain hearing aids. Standard hearing aids that I program for people with normal hearing thresholds who still struggle with sound. These devices allow me to shape the soundscape entirely. I can soften the high-pitched screech of a chair leg, dampen the intensity of chewing, reduce background noise, and even compress high frequencies to something more tolerable. Think of it like taking the top end of a piano and lowering it a few octaves so it still exists but it doesn’t hurt anymore.
I can create multiple listening programs. Different “modes” the user can switch between. Some might include masking noise. Some might have frequency compression. Some are optimized for quiet spaces where sudden sounds are more jarring. The user gets to decide. They’re not being forced to listen to their triggers. They’re learning how to control their own experience.

The Importance of Control and Consent

I often pair this with a wireless microphone. Not the kind schools use without modification, where the child is tethered to the teacher’s voice whether they want to hear it or not. That setup is common because it’s cheap and easy to implement. But it’s also invasive. Kids can’t control what they hear. If the teacher is eating chips, they hear that. If the teacher is in the bathroom, they hear that too. If they’re trying to talk to a classmate, but the teacher is speaking to someone else across the room, they still hear the teacher instead of the person they’re with.
That’s not how learning should work. And it’s not how sound therapy should work, either.
What I do instead is build in full control. The person wearing the hearing aids can turn the mic on or off. They can hand it to someone they trust, or point it like a flashlight without ever giving it up. They can mute it entirely. They can choose how and when to engage.

Collaboration and Flexibility

I also integrate custom masking programs, like Marsha Johnson does, but with more flexibility. Some programs have filtered soundscapes for soothing background input. Some are for environments where a lot of movement and noise would otherwise be overwhelming. It’s tailored to the individual. And again, the person chooses what they need, when they need it.
Marsha and I had a wonderful conversation recently, and I deeply respect her for pioneering this work. I’m not sure whether she works virtually, and I haven’t asked about her pricing structure, but I know she also uses hearing aids to stream Bluetooth-based masking programs, just like I do. Her model may involve less customization than mine, which could make it a more accessible entry point for families who don’t need the same level of intensity. If you’re local to her or looking for a simpler, more affordable starting place, she may be a great option to consider.

Preparing for Safe and Sound Protocol

Carol Ann Braley, also known as SSPYoda, once told me that what I do likely helps prepare people for Safe and Sound Protocol. The filtering I use softens the auditory system, makes it more resilient, and creates a sense of safety. It’s a gentle bridge to engagement.

Precision and Texture Matter

One of my patients is a young autistic adult with ADHD and auditory processing challenges. At first, he hated the hearing aids. Something about the sound was just off. He couldn’t explain it, but it didn’t feel right. He’s incredibly sensitive. He told me it was like sleeping on rough sheets. So I tried a different model. One that had just been released, with a smoother response. A few weeks later, he told me, “These are silk.” That’s the level of precision we’re working with. It’s not about volume. It’s about texture.

Why I Offer a Nearly Two-Month Trial

This is why I offer a two-month trial. Real-world use. School. Home. Work. If it helps, we move forward. If not, you’re only out fifty dollars for shipping. That’s it. We don’t guess. We test.

Virtual Support That Meets You Where You Are

Most audiologists are licensed in just one or two states, which means their services are limited to in-person visits in those areas. I work virtually. That means I’m in your home. I’m in your real-life environment, wherever that may be. I’ve even attended a basketball game through a laptop once, because the sound of the ball hitting the floor was hurting a child’s ears and we needed to troubleshoot it live. You don’t have to drive anywhere. You don’t have to wait six months for a local appointment. I’m one of only a handful of audiologists in the U.S. with licensure across multiple states, and as far as I know, none of the others specialize in what I do.

Radically Transparent Community

You’re always welcome to reach out directly or join my Facebook group to ask other families what their experiences have been. The group might be called “Auditory Processing Disorder,” but it includes thousands of families dealing with misophonia, hyperacusis, tinnitus, autism, ADHD, and other forms of neurodivergence. My specialty is normal hearing with sensory sensitivities. I’m fluent in ASL and I use cued speech. We talk a lot about reading, writing, emotional regulation, theory of mind, and how all of this affects school and daily life. I’ve run that group for over five years. It’s radically transparent. All perspectives are welcome. We attract professionals from all over the world. Some I’ve trained. Some have taught me. But most of what we learn comes from the lived experiences of our members.

How to Learn More or Reach Out

You can find my website and blog by clicking on my profile picture. At the bottom of each page, there’s a link to the Facebook group if you’d like to join. I also have a testimonials page, but it’s a couple years old. If you want more current feedback, feel free to go into the group and ask other families directly. Whatever they tell you is fine. But if you do hear about a problem, please let them know they’re welcome to contact me directly. I take that seriously.

This Post Started With a Question

This post came out of a real parent question. She had just read my previous essay about the problems with hearing tests in young children, and she asked what she could actually do—especially with limited resources. My first response was going to be short: just do a treatment trial. But as usual, I ran out of space in the Facebook comment box. So here’s the longer answer.

Other Providers, Collaboration, and Getting Started

There are a few other audiologists around the country who do similar work. I don’t currently have a formal referral list, but I know of a few who are open to collaboration if you’re looking for someone closer to home. Programming is everything, though, so you really need someone highly experienced. I’m happy to train people, and I do. I’m currently working with professionals in Canada, Australia, New Zealand, and the U.S. But gaining that kind of experience starts with those first few families who are open to trying something new, with guidance.
If that’s you, feel free to look around locally. Just make sure the person you choose is open to collaboration and truly willing to individualize the settings. This work is delicate. It’s layered. It’s not plug and play.

A Safe Vantage Point

The combination of hearing aids, headphones, and earplugs can give children and adults a safe vantage point. A padded place to stand before they stretch into the unknown or the uncomfortable. We don’t just shove people in the pool and hope they learn to swim.

Final Thoughts

If you’re willing to consider virtual, I’m not a bad option. Thousands of my patients are in my group and can tell you about their experiences directly. But virtual isn’t for everyone. Some people prefer the structure of in-person appointments and a more traditional clinic setting, and that’s okay too. It all comes down to what feels supportive, accessible, and right for you or your child.
Most audiologists might let you listen to a quick demo in the office. Some won’t even do that. Many only let you try something after you’ve paid in full. I don’t work that way. I offer a real-world treatment trial because I want to know it’s helping before anyone makes a long-term decision.

I may not be the worst option out there. And if you decide I’m a rotten tomato, you can throw me to the floor. No hard feelings. Just don’t swallow what doesn’t sit right with you.
If you want to be part of the conversation, I’m hosting one tonight. I posted the announcement in the group. If you miss it, don’t worry. We do them weekly.

Your voice is welcome. You’re the expert in your own lived experience.

Postscript: What I’ve Seen, and What Still Needs to Change

I’m 50 now. I was in K-12 until 1993, and I’ve watched these patterns play out over decades.

Back when I was in school, it was the kids with cochlear implants or the Cued Speech users who struggled most with acceptance. Hard-of-hearing students were somewhat more accepted, but the lines were still clear. You were either “Deaf enough” or you weren’t. And if you weren’t, your presence in the community was conditional, fragile, always at risk of being revoked.

That has improved somewhat, due to the sheer number of cochlear implant users. Cuers (as skilled English users) just learn to mask, to sign. ASL is simply an easier conversation tool and a passcode into membership to the Deaf community.

But the definition of Deafness is still based almost entirely on peripheral hearing loss.

Not auditory processing disorders. Not function. Just the numbers on an audiogram.

And so the children who function as “brain-deaf” because of severe auditory processing disorder, or the autistic children who use ASL fluently for expression but struggle to comprehend speech, are almost never granted that same access. They are rarely considered “hard of hearing,” even when their daily communication breakdowns mirror that experience exactly.

Instead, they are often accused of seeking attention. Or dismissed as too “needy.” It doesn’t matter if they are skilled signers. It doesn’t matter if ASL is the only language they can use to truly express themselves. If their hearing thresholds don’t qualify them as Deaf, they are rejected.

This leaves them isolated. Not just from hearing peers, but from the Deaf community too.

Without the opportunity for immersion and true fluency, without access to other signers outside the home or therapy room, they become language orphans. They plateau in their development. They can’t reach full fluency. And as a result, they can’t fully access learning.

Worse, they are often not given the language resources needed in the first place. So they may never develop full language competence at all. Not because they couldn’t. But because no one gave them the right tools.

Bilingualism is a gift. But partial bilingualism, when it’s mistaken for enough, can actually be a trap. It’s like being given half a dose of a medication that works, but then being told that’s all there is. And when that dose doesn’t take you far enough, you’re blamed for not getting better.

These kids deserve more.

They deserve full language access. They deserve qualified interpreters. They deserve to be in classrooms where they can actually understand and be understood. They deserve to be immersed in a language that matches their brain, not one imposed by a checklist.

I know resources are limited. But the more people we recognize as valid ASL users, the more need we create for interpreters, for Deaf educators, for ASL-accessible spaces. That means more jobs, not fewer. Growth, not depletion.

Gatekeeping doesn’t preserve resources. It just ensures they’re misallocated.

Can you imagine classrooms with children who have mixed types of hearing loss—peripheral, central, fluctuating? Some who can hear but cannot speak. Others who can speak but can’t tolerate sound. Some who live between both worlds. And all of them supported in the language they can actually access?

That’s the vision. That’s inclusion.

Bilingualism is wonderful, but only if it includes community. Without that, it’s just baby sign. It’s sign-supported English. It’s AAC with the illusion of fluency.

But ASL is a living language. And a language is only alive when it has people to speak it with.